Provider Demographics
NPI:1437855582
Name:JONES, SHANNON BRAGG (LPC, NCC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BRAGG
Last Name:JONES
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 OLD LOUISVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GUYTON
Mailing Address - State:GA
Mailing Address - Zip Code:31312-4023
Mailing Address - Country:US
Mailing Address - Phone:912-659-7901
Mailing Address - Fax:
Practice Address - Street 1:716 FLOYD AVE
Practice Address - Street 2:
Practice Address - City:GUYTON
Practice Address - State:GA
Practice Address - Zip Code:31312-4617
Practice Address - Country:US
Practice Address - Phone:912-659-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC014982101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health