MEDICARE: SHANNON MICHELLE MORALES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6686	SC

General Provider Information

NPI Number	:	1184761082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON MICHELLE MORALES

Provider Business Mailing Address
First Line	:	3201 TRENHOLM RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-3371
Country	:	US
Telephone Number	:	803-787-2306
Fax Number	:	803-790-6554

Provider Business Practice Location Address
First Line	:	3201 TRENHOLM RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29204-3371
Country	:	US
Telephone Number	:	803-787-2306
Fax Number	:	803-790-6554

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	07/08/2007

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