Provider Demographics
NPI:1639480312
Name:SHANNON, KATHLEEN BRADLEY (MA)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BRADLEY
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:964 HOLLY RD
Mailing Address - Street 2:
Mailing Address - City:BLACK MOUNTAIN
Mailing Address - State:NC
Mailing Address - Zip Code:28711-9709
Mailing Address - Country:US
Mailing Address - Phone:828-243-7988
Mailing Address - Fax:
Practice Address - Street 1:15 JANE JACOBS RD STE 102
Practice Address - Street 2:
Practice Address - City:BLACK MOUNTAIN
Practice Address - State:NC
Practice Address - Zip Code:28711
Practice Address - Country:US
Practice Address - Phone:828-243-7988
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-28
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor