Provider Demographics
NPI:1700211166
Name:THOMASON, SHANNON LAUREN (LCSW, SUDCC IV)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LAUREN
Last Name:THOMASON
Suffix:
Gender:F
Credentials:LCSW, SUDCC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S RANCHO SANTA FE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-2338
Mailing Address - Country:US
Mailing Address - Phone:760-591-0100
Mailing Address - Fax:
Practice Address - Street 1:365 S RANCHO SANTA FE
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-1720
Practice Address - Country:US
Practice Address - Phone:760-591-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1103161045390200000X
CA883551041C0700X
CA68562101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health