Provider Demographics
NPI:1114445525
Name:COLE, SHANNA (LICSW)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:COLE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:96 STAR POINT RD
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-8119
Mailing Address - Country:US
Mailing Address - Phone:205-559-2048
Mailing Address - Fax:
Practice Address - Street 1:130 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-1234
Practice Address - Country:US
Practice Address - Phone:256-506-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2174C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2174COtherLCSW