Provider Demographics
NPI:1780903088
Name:HARKER, SHELLY NICOLE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:NICOLE
Last Name:HARKER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 BOMBAY LN
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5820
Mailing Address - Country:US
Mailing Address - Phone:770-854-0872
Mailing Address - Fax:
Practice Address - Street 1:1003 BOMBAY LN
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5820
Practice Address - Country:US
Practice Address - Phone:770-854-0872
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003377103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist