Provider Demographics
NPI:1013486364
Name:TERRELL, SHANNON MICHELLE (MS, EDS, ALC, CCTP)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MICHELLE
Last Name:TERRELL
Suffix:
Gender:F
Credentials:MS, EDS, ALC, CCTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 MAXANNA DR
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36206-1148
Mailing Address - Country:US
Mailing Address - Phone:256-343-5881
Mailing Address - Fax:
Practice Address - Street 1:931 NOBLE ST STE 309
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5667
Practice Address - Country:US
Practice Address - Phone:256-343-5881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC2952A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health