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General NPI Number Information
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NPI Number | 1932531894
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Entity Type | Individual
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Provider Name | TAYLER K. SHANNON RN MA LPC LCAS NCC
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Gender | Female
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 07/08/2020
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Provider Practice Location Address
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Address Line | 1821 LENDEW ST
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City | GREENSBORO
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State | NC
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Zip | 27408-7035
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Country | US
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Telephone | 336-288-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 1821 LENDEW ST
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City | GREENSBORO
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State | NC
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Zip | 27408-7035
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 9688
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License Number State | NC
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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 | 3221
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License Number State | NC
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 147098
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License Number State | NC
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