Provider Demographics
NPI:1760731830
Name:HEATH, SHANNON J (LCPC-C, NCC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:J
Last Name:HEATH
Suffix:
Gender:F
Credentials:LCPC-C, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KIDS PEACE WAY
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3483
Mailing Address - Country:US
Mailing Address - Phone:207-667-0909
Mailing Address - Fax:
Practice Address - Street 1:16 KIDS PEACE WAY
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3483
Practice Address - Country:US
Practice Address - Phone:207-667-0909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health