Provider Demographics
NPI:1306872650
Name:SHANNON, BOBBIE H (LPC)
Entity type:Individual
Prefix:
First Name:BOBBIE
Middle Name:H
Last Name:SHANNON
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:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:TRYON
Mailing Address - State:NC
Mailing Address - Zip Code:28782-0202
Mailing Address - Country:US
Mailing Address - Phone:864-457-6315
Mailing Address - Fax:828-859-2225
Practice Address - Street 1:2143 WARRIOR DR
Practice Address - Street 2:
Practice Address - City:TRYON
Practice Address - State:NC
Practice Address - Zip Code:28782-5571
Practice Address - Country:US
Practice Address - Phone:864-457-6315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-25
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5692101YP2500X
NC2220101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC186133OtherMEDCOST
NC1406TOtherNVML BCBSNC GRP # 015HF
NC461853OtherMHN TRICARE
SCP1425Medicaid