Provider Demographics
NPI:1245570704
Name:SEA, SHANNON ELENA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:ELENA
Last Name:SEA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:ELENA
Other - Last Name:SEAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:1921 RANSOM PL
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3841
Mailing Address - Country:US
Mailing Address - Phone:615-460-4357
Mailing Address - Fax:
Practice Address - Street 1:1921 RANSOM PL
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-3841
Practice Address - Country:US
Practice Address - Phone:615-460-4357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN9572104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker