Provider Demographics
NPI:1891595914
Name:FISHER, SHAKAELAH
Entity type:Individual
Prefix:
First Name:SHAKAELAH
Middle Name:
Last Name:FISHER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 ABBEY DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4365
Mailing Address - Country:US
Mailing Address - Phone:404-996-9640
Mailing Address - Fax:404-996-9640
Practice Address - Street 1:11770 HAYNES BRIDGE RD STE 205-411
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30009-1966
Practice Address - Country:US
Practice Address - Phone:678-264-3988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health