Provider Demographics
NPI:1730414939
Name:CROSS, SHARRON LASHAWN (LPC)
Entity type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:LASHAWN
Last Name:CROSS
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 495
Mailing Address - Street 2:
Mailing Address - City:AVONDALE EST
Mailing Address - State:GA
Mailing Address - Zip Code:30002-0495
Mailing Address - Country:US
Mailing Address - Phone:404-704-2653
Mailing Address - Fax:404-745-8273
Practice Address - Street 1:2801 BUFORD HWY NE STE 540
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329
Practice Address - Country:US
Practice Address - Phone:404-907-0431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006271101YP2500X, 101YM0800X, 101YM0800X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003134391AMedicaid