Provider Demographics
NPI:1891530812
Name:DUDLEY, SHALENA CHARMAINE
Entity type:Individual
Prefix:
First Name:SHALENA
Middle Name:CHARMAINE
Last Name:DUDLEY
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 1:113 BELLINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8676
Mailing Address - Country:US
Mailing Address - Phone:860-941-4830
Mailing Address - Fax:
Practice Address - Street 1:122 N MCDONOUGH ST STE 207
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-3675
Practice Address - Country:US
Practice Address - Phone:860-941-4830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor