Provider Demographics
NPI:1295155281
Name:NICELY, SHALA (MS, LAPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SHALA
Middle Name:
Last Name:NICELY
Suffix:
Gender:F
Credentials:MS, LAPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 SANDY PLAINS RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4695
Mailing Address - Country:US
Mailing Address - Phone:404-632-4804
Mailing Address - Fax:
Practice Address - Street 1:2993 SANDY PLAINS RD
Practice Address - Street 2:SUITE 115
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4695
Practice Address - Country:US
Practice Address - Phone:404-632-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-17
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC003826101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health