Individual
BOBBIE H SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2143 WARRIOR DR, TRYON, NC 28782-5571
(864) 457-6315
Mailing address
PO BOX 202, TRYON, NC 28782-0202
(864) 457-6315
(828) 859-2225
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2220
NC
101YP2500X
Professional Counselor
5692
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1406T
NVML BCBSNC GRP # 015HF
NC
01
—
186133
MEDCOST
NC
01
—
461853
MHN TRICARE
NC
05
—
P1425
—
SC
Enumeration date
06/25/2006
Last updated
04/21/2020
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