Provider Demographics
NPI:1407272503
Name:WRIGHT, SHANNON COURTNEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:COURTNEY
Last Name:WRIGHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 RECTORY LN
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-2980
Mailing Address - Country:US
Mailing Address - Phone:434-985-5220
Mailing Address - Fax:434-985-5268
Practice Address - Street 1:24 RECTORY LN
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-2980
Practice Address - Country:US
Practice Address - Phone:434-985-5220
Practice Address - Fax:434-985-5268
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040069731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical