Healthcare Provider Details

I. General information

NPI: 1992044465
Provider Name (Legal Business Name): SHANNON FAY MATHIS MEYER LCSW, CACII
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON FAY MATHIS MEYER LCSW, LICSW, CACII

II. Dates (important events)

Enumeration Date: 02/04/2013
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3478 MARTHA BERRY HWY NE
ROME GA
30165-7713
US

IV. Provider business mailing address

8735 DUNWOODY PL STE R
ATLANTA GA
30350-2995
US

V. Phone/Fax

Practice location:
  • Phone: 404-477-4888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW005915
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5982C
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: