Shannon A Perez, MSW, LCSW, LCAS-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C014152 Issued in NC

Practice address

8128 River Rd SE
Southport, NC 28461-8972

Phone

(910) 367-5036

Fax

(910) 477-9030

NPI assigned

Jul 9, 2020

Last updated

Aug 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mindful Expressions Counseling PLLCGroup PAC ID 5698163103, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Mindful Expressions Counseling PLLC

  • Community/Behavioral Health Agency
  • Southport, NC
  • NPI 1134894850

  Clinical

  Medicare reassignment Care Compare group NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692230400000",
    "number": "1083232631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 HIGH POINT RD",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284619757",
            "telephone_number": "910-599-0993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8128 RIVER RD SE",
            "city": "SOUTHPORT",
            "state": "NC",
            "postal_code": "284618972",
            "telephone_number": "910-367-5036",
            "fax_number": "910-477-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PEREZ",
        "first_name": "SHANNON",
        "middle_name": "A",
        "name_prefix": "Mrs.",
        "credential": "MSW, LCSW, LCAS-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-09",
        "last_updated": "2023-08-17",
        "certification_date": "2023-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "25841",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P013774",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C014152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Haylie Parks Ohmer, M.ED., LCMHC, LCAS
• Jaclyn Elizabeth Parlo
• Tara Jean Parnell, OD
• Robert Scott Passingham, MPT
• Mariann Pata
• Bonnie Phillips
• Jamie O'Neal Phillips, OTR/L
• Michelle Lee Phillips, PT
• Travis Pickens, OD
• Dawn Marie Pieper, LCSW

• Clinical Social Worker in Southport, NC
• Providers in Southport, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.