Provider Demographics
NPI:1144729930
Name:GARCIA, SHANNA L (MS LPCC)
Entity type:Individual
Prefix:MRS
First Name:SHANNA
Middle Name:L
Last Name:GARCIA
Suffix:
Gender:F
Credentials:MS LPCC
Other - Prefix:
Other - First Name:SHANNA
Other - Middle Name:L
Other - Last Name:QUALLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2405 8TH ST S STE 200
Mailing Address - Street 2:
Mailing Address - City:MOORHEAD
Mailing Address - State:MN
Mailing Address - Zip Code:56560-4200
Mailing Address - Country:US
Mailing Address - Phone:218-331-4866
Mailing Address - Fax:218-331-4867
Practice Address - Street 1:2405 8TH ST S STE 200
Practice Address - Street 2:
Practice Address - City:MOORHEAD
Practice Address - State:MN
Practice Address - Zip Code:56560-4200
Practice Address - Country:US
Practice Address - Phone:218-331-4866
Practice Address - Fax:218-331-4867
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND171M00000X
MN2866101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator