Provider Demographics
NPI:1225092620
Name:ADAMS, SHANNON PONDER (LMHC RPTS)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PONDER
Last Name:ADAMS
Suffix:
Gender:F
Credentials:LMHC RPTS
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:RUTH
Other - Last Name:PONDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4220 SAXON DR
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32169-3923
Mailing Address - Country:US
Mailing Address - Phone:407-973-7098
Mailing Address - Fax:386-428-9675
Practice Address - Street 1:251 MAITLAND AVE
Practice Address - Street 2:STE 307B
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4910
Practice Address - Country:US
Practice Address - Phone:407-973-7098
Practice Address - Fax:407-332-8069
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6215101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health