Provider Demographics
NPI:1063727055
Name:BATTLE, SHANNON M (LPC, LCAS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:M
Last Name:BATTLE
Suffix:
Gender:F
Credentials:LPC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2504 RAEFORD RD
Mailing Address - Street 2:STE A
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5294
Mailing Address - Country:US
Mailing Address - Phone:910-860-9787
Mailing Address - Fax:910-860-3903
Practice Address - Street 1:2504 RAEFORD RD
Practice Address - Street 2:STE A
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5294
Practice Address - Country:US
Practice Address - Phone:910-860-9787
Practice Address - Fax:910-860-3903
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-13
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8112101YP2500X
NC1989101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112324Medicaid