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NPI Code Detail

MEDICARE: DR. SHANNON K. DUNLAP PHD

MEDICARE: DR. SHANNON K. DUNLAP PHD
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
1101YA0400XAddiction (Substance Use Disorder) Counselor202201GA
2101YP2500XProfessional CounselorLPC004718GA
3103TC0700XClinical PsychologistPSY003497GA

General Provider Information

NPI Number : 1194950857
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANNON K. DUNLAP PHD
Provider Business Mailing Address
First Line : 610 RIDLEY AVE
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2236
Country : US
Telephone Number : 706-884-5050
Fax Number : 706-884-5056
Provider Business Practice Location Address
First Line : 610 RIDLEY AVE
Second Line :
City : LAGRANGE
State : GA
Zip : 30240-2236
Country : US
Telephone Number : 706-884-5050
Fax Number : 706-884-5056
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/26/2009
Last Update Date : 02/03/2016

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