Provider Demographics
NPI:1518217686
Name:SHANNON-KIRBY, ROBERTA ANN (MA/CAS, LPA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:ANN
Last Name:SHANNON-KIRBY
Suffix:
Gender:F
Credentials:MA/CAS, LPA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:211-B HIGHWAY 127
Mailing Address - Street 2:SUITE 130
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602
Mailing Address - Country:US
Mailing Address - Phone:828-638-6681
Mailing Address - Fax:828-270-7868
Practice Address - Street 1:211-B HIGHWAY 127
Practice Address - Street 2:75 BROWNING DRIVE TAYLORSVILLE NC 28681-6642
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-3541
Practice Address - Country:US
Practice Address - Phone:828-638-6681
Practice Address - Fax:828-270-7868
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC3679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical