Provider Demographics
NPI:1356671002
Name:O'NEAL, SHANNON R (MA, LPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:R
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 KIMBERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-4579
Mailing Address - Country:US
Mailing Address - Phone:919-604-4095
Mailing Address - Fax:
Practice Address - Street 1:603 KIMBERWOOD CT
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-4579
Practice Address - Country:US
Practice Address - Phone:919-604-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-31
Last Update Date:2009-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7625101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional