Provider Demographics
NPI:1033302674
Name:BROWN, SHANNON W (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:W
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:HITCHCOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 5568
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37802-5568
Mailing Address - Country:US
Mailing Address - Phone:865-309-5427
Mailing Address - Fax:866-318-9025
Practice Address - Street 1:519 W. LAMAR ALEXANDER PARKWAY
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37801-4701
Practice Address - Country:US
Practice Address - Phone:865-309-5427
Practice Address - Fax:866-318-9025
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN54321041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ009134Medicaid