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General NPI Number Information
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NPI Number | 1083232631
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Entity Type | Individual
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Provider Name | SHANNON A PEREZ MSW, LCSW, LCAS-A
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Gender | Female
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Dates
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Enumeration Date | 07/09/2020
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Last Update Date | 08/17/2023
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Provider Practice Location Address
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Address Line | 8128 RIVER RD SE
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City | SOUTHPORT
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State | NC
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Zip | 28461-8972
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Country | US
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Telephone | 910-367-5036
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Fax | 910-477-9030
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Provider Business Mailing Address
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Address Line | 70 HIGH POINT RD
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City | SOUTHPORT
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State | NC
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Zip | 28461-9757
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Country | US
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Telephone | 910-599-0993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 25841
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P013774
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | C014152
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License Number State | NC
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