Provider Demographics
NPI:1396432514
Name:RICH, SHAVON (LPC)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:
Last Name:RICH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SIOUX ST
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36303-3259
Mailing Address - Country:US
Mailing Address - Phone:334-200-1538
Mailing Address - Fax:
Practice Address - Street 1:256 HONEYSUCKLE RD STE 24
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36305-1119
Practice Address - Country:US
Practice Address - Phone:334-405-7284
Practice Address - Fax:256-207-4720
Is Sole Proprietor?:No
Enumeration Date:2023-04-18
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC05314101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional