Shakirah Forde, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW006433 Issued in GA

Practice address

1770 Indian Trail Lilburn Rd Ste 120
Norcross, GA 30093

Phone

(678) 888-5904

NPI assigned

Aug 31, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: shakiraforde@tdh.allscriptsdirect.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Teladoc Health Medical Group, P.a.

  • Family Medicine Physician
  • Lewisville, TX
  • NPI 1245403567

  Mental Health

  NPD
• Clayton Center CSB

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Jonesboro, GA
  • NPI 1588026140
  NPD (past)
• Lucid Lane Providers, P.C.

  • Mental Health Counselor
  • San Jose, CA
  • NPI 1912507021
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1346371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574294400000",
    "number": "1821347154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "538 COUNTRY LAKE DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302522683",
            "telephone_number": "347-634-0077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 INDIAN TRAIL LILBURN RD STE 120",
            "city": "NORCROSS",
            "state": "GA",
            "postal_code": "30093",
            "telephone_number": "678-888-5904"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1345 Redmond Cir NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301651307",
            "country_code": "US",
            "telephone_number": "910-742-9243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORDE",
        "first_name": "SHAKIRAH",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-08-31",
        "last_updated": "2019-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "GA",
            "license": "CSW006433",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW006433",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Floyd Wellness Care, Corp
• Mariangel L Flynt, LPC
• Alyssa Michelle Fobb
• Focal Point Optical
• Megan Ciandra Ford
• Angelica Maria Forero, NP
• Nino Renzo Renzo Fornasini, MD
• Rakeisha Nichole Forte, NP-C
• Jean M Fortgang, NP
• Heather Nicole Forward, LCSW

• Clinical Social Worker in Norcross, GA
• Providers in Norcross, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.