Provider Demographics
NPI:1104707033
Name:CHILDERS, SHANNON STEVE
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:STEVE
Last Name:CHILDERS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 DANIELS LUMBER RD
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-3394
Mailing Address - Country:US
Mailing Address - Phone:828-216-4290
Mailing Address - Fax:
Practice Address - Street 1:105 HIDDENITE CHURCH RD
Practice Address - Street 2:
Practice Address - City:HIDDENITE
Practice Address - State:NC
Practice Address - Zip Code:28636-8168
Practice Address - Country:US
Practice Address - Phone:828-999-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty