Provider Demographics
NPI:1215190319
Name:STAIGER, SHANNON MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:STAIGER
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 1:116 STOCKTON GORGE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-6143
Mailing Address - Country:US
Mailing Address - Phone:845-901-0872
Mailing Address - Fax:845-338-6284
Practice Address - Street 1:249 E NC HIGHWAY 54
Practice Address - Street 2:320
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7512
Practice Address - Country:US
Practice Address - Phone:919-753-1080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-08
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
NC8688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist