Provider Demographics
NPI:1346510005
Name:HANEY-JENKINS, SHANNON RENE (LMFT, LCAS)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENE
Last Name:HANEY-JENKINS
Suffix:
Gender:F
Credentials:LMFT, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2530 MERIDIAN PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5273
Mailing Address - Country:US
Mailing Address - Phone:919-367-1376
Mailing Address - Fax:984-960-1978
Practice Address - Street 1:2530 MERIDIAN PKWY STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-5273
Practice Address - Country:US
Practice Address - Phone:919-367-1376
Practice Address - Fax:984-960-1978
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1435106H00000X
NC2578101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)