Provider Demographics
NPI:1851169452
Name:PATE-ANDREWS, SHANNON MONTA JR
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MONTA
Last Name:PATE-ANDREWS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3462 HALEH CIR SE APT A
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-5963
Mailing Address - Country:US
Mailing Address - Phone:616-264-7602
Mailing Address - Fax:
Practice Address - Street 1:3462 HALEH CIR SE APT A
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-5963
Practice Address - Country:US
Practice Address - Phone:616-264-7602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor