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General NPI Number Information
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NPI Number | 1558067637
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Entity Type | Individual
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Provider Name | SHANNON SUZETTE GORDON
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Gender | Female
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Dates
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Enumeration Date | 02/01/2023
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 213 PATTON DR STE B
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City | SHELBY
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State | NC
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Zip | 28150-4696
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Country | US
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Telephone | 980-465-2533
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Fax | 704-419-2065
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Provider Business Mailing Address
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Address Line | PO BOX 1084
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City | SHELBY
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State | NC
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Zip | 28151-1084
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Country | US
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Telephone | 980-318-6915
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | P018665
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P018665
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P018665
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P018665
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License Number State |
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P018665
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License Number State | NC
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