Provider Demographics
NPI:1447589411
Name:OESCH, SHANNON DIANE (LCSW, CSAC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:DIANE
Last Name:OESCH
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:909 UNIVERSITY AVE
Mailing Address - Street 2:#204
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-3262
Mailing Address - Country:US
Mailing Address - Phone:808-864-0016
Mailing Address - Fax:808-262-0970
Practice Address - Street 1:3713 HOLMES LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2012
Practice Address - Country:US
Practice Address - Phone:808-457-6336
Practice Address - Fax:855-865-0787
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2018-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040100021041C0700X
HI1493-09101YA0400X
HI37811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)