Provider Demographics
NPI:1144395252
Name:STALNAKER-SHOFNER, DEVONA M (LPC)
Entity type:Individual
Prefix:DR
First Name:DEVONA
Middle Name:M
Last Name:STALNAKER-SHOFNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-1359
Mailing Address - Country:US
Mailing Address - Phone:678-318-1994
Mailing Address - Fax:678-318-1994
Practice Address - Street 1:195 W PIKE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4966
Practice Address - Country:US
Practice Address - Phone:678-318-1994
Practice Address - Fax:678-318-1994
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004683101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional