=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952107450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHANNON DAVIS LICENSED PROFESSIONAL COUNSELING
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/24/2025
-----------------------------------------------------
Last Update Date | 02/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14323 OCEAN HWY UNIT 4103
-----------------------------------------------------
City | PAWLEYS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29585-4817
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 843-608-0884
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 114 LAKE TRL
-----------------------------------------------------
City | PAWLEYS ISLAND
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29585-7211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JULEE KRECHEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 843-458-0643
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------