Provider Demographics
NPI:1649394032
Name:PEELE, SHANNON RAE (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:RAE
Last Name:PEELE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:104 FERGUSON PL
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3259
Mailing Address - Country:US
Mailing Address - Phone:757-535-6547
Mailing Address - Fax:757-616-0738
Practice Address - Street 1:850 TIDEWATER DR
Practice Address - Street 2:SUITE A
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-3300
Practice Address - Country:US
Practice Address - Phone:757-616-0675
Practice Address - Fax:757-616-0738
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710101882101YA0400X
VA09040058491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical