1114270436 NPI number — PARIS C SHIELDS LCSW

Table of content: PARIS C SHIELDS LCSW (NPI 1114270436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114270436 NPI number — PARIS C SHIELDS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
PARIS
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114270436
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/13/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
41 GRIFFIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCDONOUGH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30253-3139
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-300-7501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
41 GRIFFIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCDONOUGH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30253-3139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-300-7501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW005676 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 104100000X , with the licence number: 005835 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CSW005676 . This is a "GEORGIA COMPOSITE BOARD OF PC, SW AND LMFT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2026 www.npivalidator.com