Provider Demographics
NPI:1891852273
Name:SHANER, TIMOTHY C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:C
Last Name:SHANER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 LACY ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27215-5341
Mailing Address - Country:US
Mailing Address - Phone:336-228-0112
Mailing Address - Fax:336-228-6994
Practice Address - Street 1:2224 LACY ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27215-5341
Practice Address - Country:US
Practice Address - Phone:336-228-0112
Practice Address - Fax:336-228-6994
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0003981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical