Provider Demographics
NPI:1376060848
Name:PARKER, SHANNON WING (LPCA)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:WING
Last Name:PARKER
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 OAK TER
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-2938
Mailing Address - Country:US
Mailing Address - Phone:850-501-4683
Mailing Address - Fax:
Practice Address - Street 1:1100 RIDGEFIELD BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806
Practice Address - Country:US
Practice Address - Phone:828-670-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12096101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional