Provider Demographics
NPI:1386989838
Name:FANNING, SHAWNA (LMHC, LADC I, CADC)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:FANNING
Suffix:
Gender:F
Credentials:LMHC, LADC I, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 COURT ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-4372
Mailing Address - Country:US
Mailing Address - Phone:339-526-2109
Mailing Address - Fax:339-207-0142
Practice Address - Street 1:310 COURT ST STE 103
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-4372
Practice Address - Country:US
Practice Address - Phone:339-526-2109
Practice Address - Fax:339-207-0142
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-10
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA13481101YA0400X
MA0401-2101YA0400X
MA1078AD101YA0400X
MA9880101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)