Provider Demographics
NPI:1922339753
Name:TODD, SHANNON DOLORES (MA LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:DOLORES
Last Name:TODD
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 COMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28806-2054
Mailing Address - Country:US
Mailing Address - Phone:828-254-5356
Mailing Address - Fax:828-259-5384
Practice Address - Street 1:2 COMPTON DR
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-2054
Practice Address - Country:US
Practice Address - Phone:828-254-5356
Practice Address - Fax:828-259-5384
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-18
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1301106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1301OtherLICENSE #: 1301