Individual
MS. SHANNON BRUCKNER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, CAADC
Contact information
Practice address
119 SYCAMORE DR, ATHENS, GA 30606-3462
(864) 659-0543
Mailing address
119 SYCAMORE DR, ATHENS, GA 30606-3462
(864) 659-0543
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
C0263
GA
1041C0700X
Clinical Social Worker
Primary
CSW006270
GA
Other
Enumeration date
05/01/2018
Last updated
09/19/2022
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