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General NPI Number Information
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NPI Number | 1518217686
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Entity Type | Individual
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Provider Name | ROBERTA ANN SHANNON-KIRBY MA/CAS, LPA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2012
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Last Update Date | 09/14/2012
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Provider Practice Location Address
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Address Line | 211-B HIGHWAY 127 75 BROWNING DRIVE TAYLORSVILLE NC 28681-6642
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City | HICKORY
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State | NC
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Zip | 28602-3541
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Country | US
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Telephone | 828-638-6681
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Fax | 828-270-7868
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Provider Business Mailing Address
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Address Line | 211-B HIGHWAY 127 SUITE 130
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City | HICKORY
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State | NC
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Zip | 28602
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Country | US
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Telephone | 828-638-6681
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Fax | 828-270-7868
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3679
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License Number State | NC
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