Provider Demographics
NPI:1770306615
Name:RAGUSA, SHANNON HAWKINS (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:HAWKINS
Last Name:RAGUSA
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 1:4045 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70806-3830
Mailing Address - Country:US
Mailing Address - Phone:225-268-0045
Mailing Address - Fax:225-387-7670
Practice Address - Street 1:4045 NORTH BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-3830
Practice Address - Country:US
Practice Address - Phone:122-526-8004
Practice Address - Fax:225-387-7670
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2767101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional