Provider Demographics
NPI:1427622448
Name:MAZZARELLA, SHANNON MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELLE
Last Name:MAZZARELLA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:WISE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:121 WEST CAMPHOR AVENUE
Mailing Address - Street 2:
Mailing Address - City:FOLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36535
Mailing Address - Country:US
Mailing Address - Phone:251-510-0897
Mailing Address - Fax:
Practice Address - Street 1:121 WEST CAMPHOR AVENUE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:251-650-2895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLPC03571101YP2500X
AL3571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional