Provider Demographics
NPI:1720741481
Name:CULPEPPER, SHATEVIA S (MS, LAPC)
Entity type:Individual
Prefix:
First Name:SHATEVIA
Middle Name:S
Last Name:CULPEPPER
Suffix:
Gender:F
Credentials:MS, LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 W POINT RD
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4061
Mailing Address - Country:US
Mailing Address - Phone:706-837-0045
Mailing Address - Fax:
Practice Address - Street 1:2233 W POINT RD
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4061
Practice Address - Country:US
Practice Address - Phone:706-837-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC008188101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health