Provider Demographics
NPI:1114263852
Name:CLAXTON, SHANNA S (MSW, LCSWA)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:S
Last Name:CLAXTON
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLY SPRINGS
Mailing Address - State:NC
Mailing Address - Zip Code:27540-8901
Mailing Address - Country:US
Mailing Address - Phone:919-937-6536
Mailing Address - Fax:
Practice Address - Street 1:503 CARTHAGE ST
Practice Address - Street 2:2ND FLOOR. SUITE 202
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4118
Practice Address - Country:US
Practice Address - Phone:919-937-6536
Practice Address - Fax:919-776-9432
Is Sole Proprietor?:No
Enumeration Date:2012-12-28
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006250104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker