Provider Demographics
NPI:1275870925
Name:CIPOLETTI, SHANNON RAE (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:CIPOLETTI
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 1:3049 ROBERT C BYRD DR
Mailing Address - Street 2:SUITE 370
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4465
Mailing Address - Country:US
Mailing Address - Phone:304-254-9854
Mailing Address - Fax:304-254-9485
Practice Address - Street 1:3049 ROBERT C BYRD DR
Practice Address - Street 2:SUITE 370
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4465
Practice Address - Country:US
Practice Address - Phone:304-254-9854
Practice Address - Fax:304-254-9485
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional