Provider Demographics
NPI:1316292170
Name:BUNNITT, SHANNON LEE (LCPC-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEE
Last Name:BUNNITT
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:LEE
Other - Last Name:MORENCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:607 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:GREENE
Mailing Address - State:ME
Mailing Address - Zip Code:04236-4148
Mailing Address - Country:US
Mailing Address - Phone:207-333-9661
Mailing Address - Fax:
Practice Address - Street 1:607 RIVER RD
Practice Address - Street 2:
Practice Address - City:GREENE
Practice Address - State:ME
Practice Address - Zip Code:04236-4148
Practice Address - Country:US
Practice Address - Phone:207-333-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3828101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional