Individual
MARY SHANNON VANSTAVOREN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P-LCSW
Contact information
Practice address
1061 HARMON AVE, SUITE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6965
Mailing address
1061 HARMON AVENUE, SUITE 1D03, FORT STEWART, GA 31314-5674
(912) 435-6965
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
C007883
NC
Other
Enumeration date
11/19/2009
Last updated
11/17/2015
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