MEDICARE: SHANNON NOE LPC

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	101Y00000X	Counselor	0701005068	VA
2	101YP2500X	Professional Counselor	0701005068	VA
3	101YM0800X	Mental Health Counselor	0701005068	VA

General Provider Information

NPI Number	:	1306553797
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON NOE LPC

Provider Business Mailing Address
First Line	:	2711 HUNTINGTON RD
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1226
Country	:	US
Telephone Number	:	434-942-5706
Fax Number	:

Provider Business Practice Location Address
First Line	:	2711 HUNTINGTON RD
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22901-1226
Country	:	US
Telephone Number	:	434-942-5706
Fax Number	:

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

Provider Enumeration Date	:	11/03/2022
Last Update Date	:	11/03/2022

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Directions to “ SHANNON NOE LPC” Practice Location

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