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NPI Code Detail

MEDICARE: MRS. SHANNON O'CONNOR MSW, LCSW, LCAS

MEDICARE:  MRS. SHANNON  O'CONNOR  MSW, LCSW, LCAS
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) Counselor1466NC
21041C0700XClinical Social WorkerC006483NC

General Provider Information

NPI Number : 1528290152
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHANNON O'CONNOR MSW, LCSW, LCAS
Provider Business Mailing Address
First Line : 202 SAND RUN RD
Second Line :
City : HAVELOCK
State : NC
Zip : 28532-7715
Country : US
Telephone Number : 252-444-2441
Fax Number :
Provider Business Practice Location Address
First Line : 3110 ARENDELL ST
Second Line : SUITE # 4
City : MOREHEAD CITY
State : NC
Zip : 28557-6511
Country : US
Telephone Number : 252-727-5488
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2009
Last Update Date : 08/16/2009

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Directions to “ MRS. SHANNON O'CONNOR MSW, LCSW, LCAS” Practice Location

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