Provider Demographics
NPI:1023722345
Name:PICKETT-MILLS, SHANNON LEDEL
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:LEDEL
Last Name:PICKETT-MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 W SQUANTUM ST APT 1004
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2111
Mailing Address - Country:US
Mailing Address - Phone:334-462-6383
Mailing Address - Fax:
Practice Address - Street 1:100 MERRIMACK ST STE 205
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1707
Practice Address - Country:US
Practice Address - Phone:978-455-0756
Practice Address - Fax:978-455-0770
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist