Provider Demographics
NPI:1609500875
Name:DRAKE, SHEANETTE S
Entity type:Individual
Prefix:
First Name:SHEANETTE
Middle Name:S
Last Name:DRAKE
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 1:368 NORWOOD CAMAK RD
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30821-5919
Mailing Address - Country:US
Mailing Address - Phone:478-456-5863
Mailing Address - Fax:
Practice Address - Street 1:368 NORWOOD CAMAK RD
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:GA
Practice Address - Zip Code:30821-5919
Practice Address - Country:US
Practice Address - Phone:478-456-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0081431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical