Provider Demographics
NPI:1316336597
Name:FOLLETT, SHANNON MARIA (MA, NCC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIA
Last Name:FOLLETT
Suffix:
Gender:F
Credentials:MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 INDEPENDENCE LANE
Mailing Address - Street 2:
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-562-4190
Mailing Address - Fax:423-562-0751
Practice Address - Street 1:203 INDEPENDENCE LN
Practice Address - Street 2:
Practice Address - City:LA FOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766-3066
Practice Address - Country:US
Practice Address - Phone:423-562-4190
Practice Address - Fax:423-562-0751
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health