MEDICARE: SHANNON R BRENNAN LCMHC, LADC

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	101YM0800X	Mental Health Counselor	19532	NC
2	101YM0800X	Mental Health Counselor	068.0081022	VT

General Provider Information

NPI Number	:	1255767497
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON R BRENNAN LCMHC, LADC

Provider Business Mailing Address
First Line	:	7406 CHAPEL HILL ROAD
Second Line	:	STE J
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	984-310-9811
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 CHAPEL HILL ROAD
Second Line	:	STE J
City	:	RALEIGH
State	:	NC
Zip	:	27607-5039
Country	:	US
Telephone Number	:	984-310-9811
Fax Number	:	919-573-0438

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

Provider Enumeration Date	:	09/19/2013
Last Update Date	:	06/02/2024

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