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General NPI Number Information
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NPI Number | 1386625648
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Entity Type | Organization
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Legal Business Name | SHANNON WOOD WILLIAMS LMFT, INC
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Dates
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Enumeration Date | 11/12/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 730 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2436
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Country | US
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Telephone | 850-769-3756
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Fax | 850-769-3757
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Provider Business Mailing Address
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Address Line | 730 JENKS AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2436
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Country | US
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Telephone | 850-769-3756
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Fax | 850-769-3757
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | MS. SHANNON GAIL WOOD-WILLIAMS
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Credential | MS
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Telephone | 850-769-3756
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT0001097
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License Number State | FL
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