Provider Demographics
NPI:1982340923
Name:MILLAN, SHANNON (LAPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:MILLAN
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 SUMMERTIME DR
Mailing Address - Street 2:
Mailing Address - City:WINTERVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30683-1439
Mailing Address - Country:US
Mailing Address - Phone:352-317-1649
Mailing Address - Fax:
Practice Address - Street 1:598 S MILLEDGE AVE STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-1262
Practice Address - Country:US
Practice Address - Phone:706-919-9392
Practice Address - Fax:706-395-6573
Is Sole Proprietor?:No
Enumeration Date:2022-05-11
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health