Provider Demographics
NPI:1285376731
Name:CONNOLLY, SHANNON TAKODA (LPC)
Entity type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:TAKODA
Last Name:CONNOLLY
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 1:5701 N HIGH ST STE 308
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3960
Mailing Address - Country:US
Mailing Address - Phone:614-406-0299
Mailing Address - Fax:
Practice Address - Street 1:5701 N HIGH ST STE 308
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3960
Practice Address - Country:US
Practice Address - Phone:614-406-0299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103752101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health