Shannon Lee Davis, SUDCC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

Practice address

16248 Victor St
Victorville, CA 92395-3934

Phone

(760) 243-7151

NPI assigned

Sep 21, 2022

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Shannon Black Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1487377784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 WINDY PASS SPC 154",
            "city": "BARSTOW",
            "state": "CA",
            "postal_code": "923115476",
            "telephone_number": "442-455-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16248 VICTOR ST",
            "city": "VICTORVILLE",
            "state": "CA",
            "postal_code": "923953934",
            "telephone_number": "760-243-7151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "SHANNON",
        "middle_name": "LEE",
        "credential": "SUDCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SUBSTANCE USE DISORDER",
            "identifier": "B3727585",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "BLACK",
            "credential": "SUDRC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kathy A Davis, LMFT
• Leila Davis
• Martha Davis
• Roxanna Davis
• Samantha Louise Davis, RADTI
• William Davtyan, RADTI
• Doreen Dawson
• Abdul-Hakim Jeremiah Day
• Rebecca Reyes De Golier, DMD
• Erica De Jager

• Addiction (Substance Use Disorder) Counselor in Victorville, CA
• Providers in Victorville, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.