Provider Demographics
NPI:1578126371
Name:DANCY, SHANNA
Entity Type:Individual
Prefix:MISS
First Name:SHANNA
Middle Name:
Last Name:DANCY
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 1:4072 CRESTON ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-4423
Mailing Address - Country:US
Mailing Address - Phone:267-536-8455
Mailing Address - Fax:
Practice Address - Street 1:4072 CRESTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-4423
Practice Address - Country:US
Practice Address - Phone:267-536-8455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-17
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor