Provider Demographics
NPI:1124300223
Name:CRENSHAW, SHANNON S (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:S
Last Name:CRENSHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 PARKWAY E
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35206-1504
Mailing Address - Country:US
Mailing Address - Phone:205-835-9052
Mailing Address - Fax:205-623-3682
Practice Address - Street 1:8825 PARKWAY E
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35206-1504
Practice Address - Country:US
Practice Address - Phone:205-835-9052
Practice Address - Fax:205-623-3682
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL2945172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker