Provider Demographics
NPI:1528290152
Name:O'CONNOR, SHANNON (MSW, LCSW, LCAS)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSW, LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 SAND RUN RD
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-7715
Mailing Address - Country:US
Mailing Address - Phone:252-444-2441
Mailing Address - Fax:
Practice Address - Street 1:3110 ARENDELL ST
Practice Address - Street 2:SUITE # 4
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-6511
Practice Address - Country:US
Practice Address - Phone:252-727-5488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-16
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1466101YA0400X
NCC0064831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)