Provider Demographics
NPI:1659058717
Name:STOKES, SHANNYN (LACA, CADAC II)
Entity Type:Individual
Prefix:
First Name:SHANNYN
Middle Name:
Last Name:STOKES
Suffix:
Gender:F
Credentials:LACA, CADAC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 SYCAMORE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7813
Mailing Address - Country:US
Mailing Address - Phone:317-427-3963
Mailing Address - Fax:
Practice Address - Street 1:2680 E MAIN ST STE 314A
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IN
Practice Address - Zip Code:46168-2829
Practice Address - Country:US
Practice Address - Phone:317-427-3963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86900011A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)