Healthcare Provider Details

I. General information

NPI: 1669027926
Provider Name (Legal Business Name): SHANNON LYNN CULLERS M.ED, LADAC II
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LYNN GENZ M.ED, LADAC

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 11/27/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 METROPLEX DR STE 200A
NASHVILLE TN
37211-3139
US

IV. Provider business mailing address

446 METROPLEX DR
NASHVILLE TN
37211-3186
US

V. Phone/Fax

Practice location:
  • Phone: 615-970-6260
  • Fax: 615-970-6267
Mailing address:
  • Phone: 615-970-6260
  • Fax: 615-970-6267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number972
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: