Healthcare Provider Details

I. General information

NPI: 1942097720
Provider Name (Legal Business Name): SHANNON CHRISTINE COOK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANNON CHRISTINE COOK CDCA PRELIMINARY

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E CENTER ST
MARION OH
43302-4235
US

IV. Provider business mailing address

1856 CEDAR HILL RD
LANCASTER OH
43130-4178
US

V. Phone/Fax

Practice location:
  • Phone: 740-692-9022
  • Fax:
Mailing address:
  • Phone: 740-796-8835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: