Provider Demographics
NPI:1477687416
Name:NELSON, SHANNA DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:DENISE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:SHANNA
Other - Middle Name:DENISE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4011 HEPBURN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90008-2736
Mailing Address - Country:US
Mailing Address - Phone:323-296-0124
Mailing Address - Fax:
Practice Address - Street 1:5901 E 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90822-5201
Practice Address - Country:US
Practice Address - Phone:562-826-8000
Practice Address - Fax:562-826-5471
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16583101YM0800X
CA251581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health