Provider Demographics
NPI:1447294061
Name:HARTMAN-WILSON, SHANNON ALISON (MA, LMFT, LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ALISON
Last Name:HARTMAN-WILSON
Suffix:
Gender:F
Credentials:MA, LMFT, LPC, NCC
Other - Prefix:MISS
Other - First Name:SHANNON
Other - Middle Name:ALISON
Other - Last Name:HARTMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 1963
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-1963
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:126 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 2B
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036
Practice Address - Country:US
Practice Address - Phone:704-655-2827
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4390101YP2500X
NC963106H00000X
CA39135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC135JJOtherBLUECROSS BLUESHIELD