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General NPI Number Information
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NPI Number | 1447294061
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Entity Type | Individual
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Provider Name | SHANNON ALISON HARTMAN-WILSON MA, LMFT,
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Gender | Female
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 5410 EAST 30A SUITE 212
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-607-9108
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Fax |
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Provider Business Mailing Address
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Address Line | 29 CAMP SHOAL DR
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459-0642
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Country | US
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Telephone | 850-608-9108
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 39135
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 963
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License Number State | NC
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