Provider Demographics
NPI:1215190319
Name:STAIGER, SHANNON MARIE (LCMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:STAIGER
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 HORSESHOE PL
Mailing Address - Street 2:
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501-6307
Mailing Address - Country:US
Mailing Address - Phone:919-630-5668
Mailing Address - Fax:984-459-8381
Practice Address - Street 1:235 HORSESHOE PL
Practice Address - Street 2:
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501-6307
Practice Address - Country:US
Practice Address - Phone:919-630-5668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103T00000X
NC8688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist