Provider Demographics
NPI:1659498335
Name:ROCKNICH, SHAWNA LEE (MA)
Entity Type:Individual
Prefix:MISS
First Name:SHAWNA
Middle Name:LEE
Last Name:ROCKNICH
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 1:5891 DAVIS CREEK RD #5
Mailing Address - Street 2:
Mailing Address - City:BARBOURSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25504-1153
Mailing Address - Country:US
Mailing Address - Phone:304-733-3862
Mailing Address - Fax:
Practice Address - Street 1:1401 HOSPITAL DR
Practice Address - Street 2:STE 106
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9237
Practice Address - Country:US
Practice Address - Phone:304-757-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1645101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional