Active NPI
Shelly Wong Cordsen, LPC
- Professional Counselor
- Lawrenceville, GA
National Provider Identifier
1023334984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- LPC005306
- Practice address
- 11 Lumpkin St Ste 100
Lawrenceville, GA 30046-8451 - Phone
- (678) 404-0112
- NPI assigned
- Apr 15, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | LPC005306 | GA | Primary |
| Mental Health Counselor | 101YM0800X | LPC005306 | GA | |
| Psychoanalyst | 102L00000X | LPC005306 | GA |
Addresses
Primary practice location
11 Lumpkin St Ste 100
Lawrenceville, GA 30046-8451
Mailing address
PO Box 454
Suwanee, GA 30024-0454
Phone (678) 404-0112
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 15, 2026 through Jun 15, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LPC005306 | GA | MD | Psychoanalyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1271289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364774400000",
"number": "1023334984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 454",
"city": "SUWANEE",
"state": "GA",
"postal_code": "300240454",
"telephone_number": "678-404-0112"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 LUMPKIN ST STE 100",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300468451",
"telephone_number": "678-404-0112"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CORDSEN",
"first_name": "SHELLY",
"middle_name": "WONG",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-15",
"last_updated": "2013-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "GA",
"license": "LPC005306",
"primary": true
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "GA",
"license": "LPC005306",
"primary": false
},
{
"code": "102L00000X",
"taxonomy_group": "",
"desc": "Psychoanalyst",
"state": "GA",
"license": "LPC005306",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lawrenceville, GA
- Jessica Corbin, LPC
- Teria K Corbin
- Darrell Frank Corder
- Jose Antonio Cordero, ED.M., LAPC
- Cordinat Medical Staffing and Consulting
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- Karyn Corell, LPC
- Corinne F. Quinn M.D., P.C.
- Myra R Cornelius, LCSW
- Sierra Elexus Mercedes Cornelous
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.