Provider Demographics
NPI:1346604972
Name:ESTEVES, SHANNON LEAH (MS,LPC,LCADC,NCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEAH
Last Name:ESTEVES
Suffix:
Gender:F
Credentials:MS,LPC,LCADC,NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 WASHINGTON ST STE C2
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-7582
Mailing Address - Country:US
Mailing Address - Phone:732-592-9398
Mailing Address - Fax:
Practice Address - Street 1:252 WASHINGTON ST STE C2
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-7582
Practice Address - Country:US
Practice Address - Phone:732-592-9398
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-09
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00281500106H00000X
NJ37PC00628400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist