Provider Demographics
NPI:1528694742
Name:SHANNON, GREGORY JOHNSTON (LPC)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:JOHNSTON
Last Name:SHANNON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WELLINGTON RD
Mailing Address - Street 2:
Mailing Address - City:SHAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18708-1341
Mailing Address - Country:US
Mailing Address - Phone:412-860-9804
Mailing Address - Fax:
Practice Address - Street 1:117 WELLINGTON RD
Practice Address - Street 2:
Practice Address - City:SHAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18708-1341
Practice Address - Country:US
Practice Address - Phone:412-860-9804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional