Provider Demographics
NPI:1114684875
Name:WILLIAMS, SHANNA MICHELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MICHELLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 N 31ST ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19121-3870
Mailing Address - Country:US
Mailing Address - Phone:267-209-3323
Mailing Address - Fax:
Practice Address - Street 1:1410 N 31ST ST # 1776
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19121-3870
Practice Address - Country:US
Practice Address - Phone:267-209-3323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0178641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical