Healthcare Provider Details

I. General information

NPI: 1780378471
Provider Name (Legal Business Name): SHANNON CLARK LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 JACKSON ST
CALHOUN FALLS SC
29628-1222
US

IV. Provider business mailing address

313 MAIN ST STE B
GREENWOOD SC
29646-2757
US

V. Phone/Fax

Practice location:
  • Phone: 864-418-8578
  • Fax: 864-418-8203
Mailing address:
  • Phone: 864-330-8240
  • Fax: 864-943-1120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number19135
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: