Basic Information
| Provider Information | |||||||||
| NPI: | 1639784861 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHOULDERS | ||||||||
| FirstName: | YVETTE | ||||||||
| MiddleName: | ELIZABETH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5124 GREAT MEADOWS RD | ||||||||
| Address2: | |||||||||
| City: | LITHONIA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300382799 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477171778 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 733 SECOND AVENUE | ||||||||
| Address2: | FRANK R. FERGUSON BUILDING | ||||||||
| City: | KOTZEBUE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 99752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9074427640 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2020 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 153656 | AK | N | Behavioral Health & Social Service Providers | Social Worker | 104100000X | MSW008794 | GA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.