Provider Demographics
NPI:1316762073
Name:DICKERSON, SHANNON MCCUNE (MED, LMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MCCUNE
Last Name:DICKERSON
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:MCCUNE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LMHC
Mailing Address - Street 1:1303 ASTOR ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2915
Mailing Address - Country:US
Mailing Address - Phone:360-287-4855
Mailing Address - Fax:
Practice Address - Street 1:1303 ASTOR ST STE 102
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-2915
Practice Address - Country:US
Practice Address - Phone:360-287-4855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH61417741101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health