Provider Demographics
NPI:1598109308
Name:MORGAN, SHANNON LESLIE
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LESLIE
Last Name:MORGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LESLIE
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ASW
Mailing Address - Street 1:11615 ARNO RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CA
Mailing Address - Zip Code:95693-8550
Mailing Address - Country:US
Mailing Address - Phone:916-519-3626
Mailing Address - Fax:
Practice Address - Street 1:7600 GREENHAVEN DR STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-5640
Practice Address - Country:US
Practice Address - Phone:916-422-2556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)