Healthcare Provider Details

I. General information

NPI: 1134427990
Provider Name (Legal Business Name): SHANNON MARIE HAIGLER MSBS, LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2011
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 COMMERCE AVE
CHESTERFIELD SC
29709
US

IV. Provider business mailing address

P.O. BOX 918
BENNETTSVILLE SC
29512
US

V. Phone/Fax

Practice location:
  • Phone: 843-623-2229
  • Fax: 803-773-5246
Mailing address:
  • Phone: 843-544-4098
  • Fax: 803-773-6615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6062LPCE
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberSC6062
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: