Provider Demographics
NPI:1750858189
Name:SHADIX, SHANNON R (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:R
Last Name:SHADIX
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 STURGESS RUN
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-6906
Mailing Address - Country:US
Mailing Address - Phone:785-249-1025
Mailing Address - Fax:
Practice Address - Street 1:225 MILLARD FARMER IND BLVD
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-3168
Practice Address - Country:US
Practice Address - Phone:678-854-6625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC010552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional