Provider Demographics
NPI:1144672601
Name:PALMER, SHAWNEE (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:SHAWNEE
Middle Name:
Last Name:PALMER
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 SMITH CORNERS BLVD # 1198
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28269-3793
Mailing Address - Country:US
Mailing Address - Phone:314-516-3718
Mailing Address - Fax:314-648-2847
Practice Address - Street 1:7014 SMITH CORNERS BLVD # 1198
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-3793
Practice Address - Country:US
Practice Address - Phone:314-516-3718
Practice Address - Fax:314-648-2847
Is Sole Proprietor?:No
Enumeration Date:2016-07-08
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20170351771041C0700X
COCSW.099249391041C0700X
NCC0160571041C0700X
IL149.0206431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
5630261OtherCIGNA
21205OtherMORNEAU SHEPELL
MO490049177Medicaid
NC1164964813Medicaid