Provider Demographics
NPI:1700695764
Name:SHANNON, TREVOR (PHD)
Entity type:Individual
Prefix:DR
First Name:TREVOR
Middle Name:
Last Name:SHANNON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3124 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-6414
Mailing Address - Country:US
Mailing Address - Phone:910-551-1127
Mailing Address - Fax:
Practice Address - Street 1:3124 CABOT DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-6414
Practice Address - Country:US
Practice Address - Phone:910-551-1127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-04
Last Update Date:2025-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical