Provider Demographics
NPI:1487108361
Name:WORLEY, SHANNON LEIGH (LCSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:WORLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OBRIANS WAY
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-8517
Mailing Address - Country:US
Mailing Address - Phone:828-712-1603
Mailing Address - Fax:
Practice Address - Street 1:3 OBRIANS WAY
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-8517
Practice Address - Country:US
Practice Address - Phone:828-712-1603
Practice Address - Fax:828-544-1201
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-09
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0117221041C0700X
NCP0109311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP010931OtherLICENSURE