Provider Demographics
NPI:1699216481
Name:MONCK, SHANNON (MA, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MONCK
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 NEWBERRY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4828
Mailing Address - Country:US
Mailing Address - Phone:352-373-8189
Mailing Address - Fax:
Practice Address - Street 1:3919 NEWBERRY RD STE 5
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-4828
Practice Address - Country:US
Practice Address - Phone:352-373-8189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health