MEDICARE: MS. SHANNON RAE PEELE LCSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	0710101882	VA
2	1041C0700X	Clinical Social Worker	0904005849	VA

General Provider Information

NPI Number	:	1649394032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON RAE PEELE LCSW

Provider Business Mailing Address
First Line	:	104 FERGUSON PL
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3259
Country	:	US
Telephone Number	:	757-535-6547
Fax Number	:	757-616-0738

Provider Business Practice Location Address
First Line	:	850 TIDEWATER DR
Second Line	:	SUITE A
City	:	NORFOLK
State	:	VA
Zip	:	23504-3300
Country	:	US
Telephone Number	:	757-616-0675
Fax Number	:	757-616-0738

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	09/11/2025

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