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General NPI Number Information
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NPI Number | 1447589411
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Entity Type | Individual
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Provider Name | SHANNON DIANE OESCH LCSW, CSAC
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Gender | Female
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Dates
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Enumeration Date | 12/21/2009
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Last Update Date | 01/04/2018
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Provider Practice Location Address
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Address Line | 3713 HOLMES LN
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City | ALEXANDRIA
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State | VA
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Zip | 22302-2012
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Country | US
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Telephone | 808-457-6336
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Fax | 855-865-0787
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Provider Business Mailing Address
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Address Line | 909 UNIVERSITY AVE #204
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City | HONOLULU
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State | HI
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Zip | 96826-3262
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Country | US
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Telephone | 808-864-0016
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Fax | 808-262-0970
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 0904010002
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1493-09
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License Number State | HI
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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 | 3781
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License Number State | HI
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