Doctor Name: | MS. SHANNON CODY ROBERTSON |
NPI Number: | 1144483736 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 10 Lee Road 546 Smiths, AL - 368774624 |
Business Phone Number: | 7063175001 |
Business Fax Number: | 7063175004 |
Mailing Address: | 10 Lee Road 546, SMITHS |
State: | AL |
Postal Code: | 368774624 |
Phone Number: | 7063175001 |
Fax Number: | 7063175004 |
NPI Enumeration Date: | 07/03/2008 |
NPI Last Update Date: | 07/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |