Provider Demographics
NPI:1780421602
Name:WARREN, SHAWNESE (ALC)
Entity type:Individual
Prefix:
First Name:SHAWNESE
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201381
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36120-1381
Mailing Address - Country:US
Mailing Address - Phone:334-801-4664
Mailing Address - Fax:
Practice Address - Street 1:7065 FAIN PARK DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-7862
Practice Address - Country:US
Practice Address - Phone:334-647-1047
Practice Address - Fax:256-719-3252
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-09
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 103TC1900X, 103TC2200X
ALC4001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent