Provider Demographics
NPI:1851864821
Name:BROCK, SHAWNNEICE BETH (MSW, LICSW, PIP)
Entity type:Individual
Prefix:
First Name:SHAWNNEICE
Middle Name:BETH
Last Name:BROCK
Suffix:
Gender:F
Credentials:MSW, LICSW, PIP
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LICSW, PIP
Mailing Address - Street 1:SPARKS CENTER 1720 7TH AVENUE SOUTH- 9TH FLOOR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0017
Mailing Address - Country:US
Mailing Address - Phone:205-934-5201
Mailing Address - Fax:205-975-4879
Practice Address - Street 1:SPARKS CENTER 1720 7TH AVENUE SOUTH- 9TH FLOOR
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0017
Practice Address - Country:US
Practice Address - Phone:205-934-5201
Practice Address - Fax:205-975-4879
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL0581C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical