Provider Demographics
NPI:1942460969
Name:WARDEN, SHANNON PRATER (MAED, LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:PRATER
Last Name:WARDEN
Suffix:
Gender:F
Credentials:MAED, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5172 BEULAH LN
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9605
Mailing Address - Country:US
Mailing Address - Phone:336-595-3493
Mailing Address - Fax:
Practice Address - Street 1:5172 BEULAH LN
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9605
Practice Address - Country:US
Practice Address - Phone:336-595-3493
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3676101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional