Provider Demographics
NPI:1033979729
Name:WILLIAMS, SHANNON ROBERTA (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ROBERTA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 HOBBYHORSE AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-2227
Mailing Address - Country:US
Mailing Address - Phone:702-374-6517
Mailing Address - Fax:
Practice Address - Street 1:1650 SILVER HAWK AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-3265
Practice Address - Country:US
Practice Address - Phone:702-799-5790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9723-M104100000X
NV1193681041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No104100000XBehavioral Health & Social Service ProvidersSocial Worker