Provider Demographics
NPI:1447556659
Name:ATKINSON, SHANNON ASHLEY
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:ASHLEY
Last Name:ATKINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 WOODRUN CT
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9160
Mailing Address - Country:US
Mailing Address - Phone:540-772-4510
Mailing Address - Fax:
Practice Address - Street 1:1355 WOODRUN CT
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9160
Practice Address - Country:US
Practice Address - Phone:540-772-4510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA09040059441041C0700X
NCC0091341041C0700X
SC107001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health