Provider Demographics
NPI:1336321744
Name:SHORTT, SAMMI NICHOLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SAMMI
Middle Name:NICHOLE
Last Name:SHORTT
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 1:2300 LAFAYETTE PKWY APT 125
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2561
Mailing Address - Country:US
Mailing Address - Phone:334-559-2321
Mailing Address - Fax:
Practice Address - Street 1:2300 LAFAYETTE PKWY APT 125
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2561
Practice Address - Country:US
Practice Address - Phone:334-559-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2049C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical