Provider Demographics
NPI:1417203878
Name:LEARY, SHANNON N (LPC, NCC, CSAC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:N
Last Name:LEARY
Suffix:
Gender:F
Credentials:LPC, NCC, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 OLD OYSTER POINT RD
Mailing Address - Street 2:STE. 250
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23602-7121
Mailing Address - Country:US
Mailing Address - Phone:757-969-6848
Mailing Address - Fax:757-969-6849
Practice Address - Street 1:1 OLD OYSTER POINT RD
Practice Address - Street 2:STE. 250
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-7121
Practice Address - Country:US
Practice Address - Phone:757-969-6848
Practice Address - Fax:757-969-6849
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102436101YA0400X
VA0701005299101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)