Provider Demographics
NPI:1508139346
Name:DURHAM, SHANNON R
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:R
Last Name:DURHAM
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 1:2356 FREEDOM BLVD
Mailing Address - Street 2:APT. #C8
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29505-6093
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2356 FREEDOM BLVD
Practice Address - Street 2:APT. #C8
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29505-6093
Practice Address - Country:US
Practice Address - Phone:240-446-1908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst