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General NPI Number Information
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NPI Number | 1225092620
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Entity Type | Individual
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Provider Name | SHANNON PONDER ADAMS LMHC RPTS
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Gender | Female
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Dates
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Enumeration Date | 04/13/2006
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 251 MAITLAND AVE STE 307B
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32701-4910
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Country | US
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Telephone | 407-973-7098
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Fax | 407-332-8069
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Provider Business Mailing Address
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Address Line | 4220 SAXON DR
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-3923
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Country | US
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Telephone | 407-973-7098
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Fax | 386-428-9675
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6215
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License Number State | FL
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