Provider Demographics
NPI:1457507725
Name:WHITE, SHANNON STONER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:STONER
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 E FIFTH ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28204-2379
Mailing Address - Country:US
Mailing Address - Phone:704-375-5354
Mailing Address - Fax:704-375-3069
Practice Address - Street 1:233 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8039
Practice Address - Country:US
Practice Address - Phone:704-375-5354
Practice Address - Fax:704-375-3069
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7553101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health