Provider Demographics
NPI:1447294061
Name:HARTMAN-WILSON, SHANNON ALISON (MA, LMFT,)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ALISON
Last Name:HARTMAN-WILSON
Suffix:
Gender:F
Credentials:MA, LMFT,
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:ALISON
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA,LMFT
Mailing Address - Street 1:29 CAMP SHOAL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-0642
Mailing Address - Country:US
Mailing Address - Phone:850-608-9108
Mailing Address - Fax:
Practice Address - Street 1:5410 EAST 30A
Practice Address - Street 2:SUITE 212
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459
Practice Address - Country:US
Practice Address - Phone:850-607-9108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39135106H00000X, 106H00000X
NC963106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135JJOtherBLUECROSS BLUESHIELD