Provider Demographics
NPI:1033589387
Name:CHAVIS, SHANNON LAMAR (LMHC, CAP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAMAR
Last Name:CHAVIS
Suffix:
Gender:M
Credentials:LMHC, CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 OLD MIDDLEBURG RD N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1170
Mailing Address - Country:US
Mailing Address - Phone:850-284-9555
Mailing Address - Fax:
Practice Address - Street 1:1390 OLD MIDDLEBURG RD N
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-1170
Practice Address - Country:US
Practice Address - Phone:850-284-9555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5894101YA0400X
FLMH17417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)