Provider Demographics
NPI:1699400028
Name:SHANNON K. GARRETT-REDMOND LLC
Entity type:Organization
Organization Name:SHANNON K. GARRETT-REDMOND LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARRETT-REDMOND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:434-249-0167
Mailing Address - Street 1:6440 THOMAS JEFFERSON PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-6216
Mailing Address - Country:US
Mailing Address - Phone:434-249-0167
Mailing Address - Fax:
Practice Address - Street 1:6440 THOMAS JEFFERSON PKWY STE F
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963-6216
Practice Address - Country:US
Practice Address - Phone:434-249-0167
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-20
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA090401148OtherLCSW LICENSE