Provider Demographics
NPI:1780464354
Name:REID, SHAKEEMA
Entity type:Individual
Prefix:
First Name:SHAKEEMA
Middle Name:
Last Name:REID
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 1:639 GARDEN WALK BLVD APT 405
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6612
Mailing Address - Country:US
Mailing Address - Phone:678-508-2171
Mailing Address - Fax:
Practice Address - Street 1:639 GARDEN WALK BLVD APT 405
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-6612
Practice Address - Country:US
Practice Address - Phone:678-508-2171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No171M00000XOther Service ProvidersCase Manager/Care Coordinator