Provider Demographics
NPI:1942432885
Name:UPSHAW, WAIKIKI L (EDD, LPC, CPCS)
Entity type:Individual
Prefix:DR
First Name:WAIKIKI
Middle Name:L
Last Name:UPSHAW
Suffix:
Gender:F
Credentials:EDD, LPC, CPCS
Other - Prefix:
Other - First Name:WAIKIKI
Other - Middle Name:L
Other - Last Name:RUTLEDGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:170 BROOKSTONE CRST
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2270
Mailing Address - Country:US
Mailing Address - Phone:678-877-1395
Mailing Address - Fax:
Practice Address - Street 1:170 BROOKSTONE CRST
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2270
Practice Address - Country:US
Practice Address - Phone:678-877-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-11
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004680101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional