Provider Demographics
NPI:1114199213
Name:ROHR, SHANNON NACOLE (MA)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:NACOLE
Last Name:ROHR
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 N NOVA RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-4447
Mailing Address - Country:US
Mailing Address - Phone:386-898-5003
Mailing Address - Fax:386-675-6490
Practice Address - Street 1:533 N NOVA RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-4447
Practice Address - Country:US
Practice Address - Phone:386-898-5003
Practice Address - Fax:386-675-6490
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH-6627101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health