Provider Demographics
NPI:1386284743
Name:THOMASSON, SHANISE
Entity type:Individual
Prefix:
First Name:SHANISE
Middle Name:
Last Name:THOMASSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7855 CEDAR GROVE RD APT 1205
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-2328
Mailing Address - Country:US
Mailing Address - Phone:209-986-0526
Mailing Address - Fax:
Practice Address - Street 1:7855 CEDAR GROVE RD APT 1205
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-2328
Practice Address - Country:US
Practice Address - Phone:209-986-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No171M00000XOther Service ProvidersCase Manager/Care Coordinator