Provider Demographics
NPI:1588152052
Name:GOOLSBY, SHAR (LPCC)
Entity type:Individual
Prefix:
First Name:SHAR
Middle Name:
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 NISKEY LAKE RD SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6310
Mailing Address - Country:US
Mailing Address - Phone:202-631-4697
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA ST STE A601
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2488
Practice Address - Country:US
Practice Address - Phone:404-590-5042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.00014370225200000X
VA2306602655225200000X
COLPCC0022669101YM0800X
GAA000863225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant