Provider Demographics
NPI:1700125465
Name:CONEY, SHANNON MARTIN (LPC, LCAS)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:MARTIN
Last Name:CONEY
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 PATTON HILL RD
Mailing Address - Street 2:
Mailing Address - City:SWANNANOA
Mailing Address - State:NC
Mailing Address - Zip Code:28778-2407
Mailing Address - Country:US
Mailing Address - Phone:828-243-4200
Mailing Address - Fax:
Practice Address - Street 1:247 PATTON HILL RD
Practice Address - Street 2:
Practice Address - City:SWANNANOA
Practice Address - State:NC
Practice Address - Zip Code:28778-2407
Practice Address - Country:US
Practice Address - Phone:828-243-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-31
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3197101YA0400X
NC9937101YP2500X
9937101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3197OtherLICENSE-LCAS
NC9937OtherLICENSE-LPC