Provider Demographics
NPI:1235488743
Name:DEAN, SHARRAL M (LPC)
Entity type:Individual
Prefix:
First Name:SHARRAL
Middle Name:M
Last Name:DEAN
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 1:277 MLK BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3498
Mailing Address - Country:US
Mailing Address - Phone:478-745-2811
Mailing Address - Fax:478-745-0881
Practice Address - Street 1:277 MLK BLVD STE 203
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3498
Practice Address - Country:US
Practice Address - Phone:478-745-2811
Practice Address - Fax:478-745-0881
Is Sole Proprietor?:No
Enumeration Date:2012-08-30
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional