Provider Demographics
NPI:1811445950
Name:TABOR, SHANNON (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:TABOR
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 1:12 THURLAND AVE
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2428
Mailing Address - Country:US
Mailing Address - Phone:828-585-4066
Mailing Address - Fax:
Practice Address - Street 1:20 BATTERY PARK AVE STE 816
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-2878
Practice Address - Country:US
Practice Address - Phone:828-585-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-19
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1300341101YM0800X
NC14023101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health