Provider Demographics
NPI:1205175288
Name:BARTLETT, SHANNON LYNN (MSW, LCSWA)
Entity type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LYNN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:MSW, LCSWA
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:LYNN
Other - Last Name:BUCKALEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:301 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 202-B
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-2981
Mailing Address - Country:US
Mailing Address - Phone:704-403-2692
Mailing Address - Fax:
Practice Address - Street 1:301 MEDICAL PARK DR
Practice Address - Street 2:SUITE 202-B
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2981
Practice Address - Country:US
Practice Address - Phone:704-403-2692
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP006197101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health