Provider Demographics
NPI:1366841835
Name:SHANNON, ALICIA M (LCSW, PIP)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:M
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LCSW, PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:858 TYLER CIR
Mailing Address - Street 2:APARTMENT E
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-5302
Mailing Address - Country:US
Mailing Address - Phone:205-677-3112
Mailing Address - Fax:
Practice Address - Street 1:3825 LORNA RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3005
Practice Address - Country:US
Practice Address - Phone:205-677-3112
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-20
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3499C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical