Provider Demographics
NPI:1053479808
Name:NELMES, SHANNON PRINCE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PRINCE
Last Name:NELMES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:454 S ANDERSON RD
Mailing Address - Street 2:BOX 583
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730-3392
Mailing Address - Country:US
Mailing Address - Phone:803-517-7363
Mailing Address - Fax:803-366-2037
Practice Address - Street 1:454 S ANDERSON RD
Practice Address - Street 2:BOX 583
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730-3392
Practice Address - Country:US
Practice Address - Phone:803-517-7363
Practice Address - Fax:803-366-2037
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4052101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional