Shannon Nicole Fain

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P007691 Issued in NC

Practice address

200 W Parkview Dr
Suite a
Henderson, NC 27536-5958

Phone

(252) 572-2663

NPI assigned

Jun 24, 2013

Last updated

Jun 24, 2013By 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 1

Addresses

Other names 1

• Shannon Nicole Jordan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Wholistic Health and Wellness PLLC

  • Clinical Social Worker
  • Rolesville, NC
  • NPI 1104773167
  NPD Authorized official

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

{
    "created_epoch": "1372032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372032000000",
    "number": "1770922619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4748 COURTNEY LN",
            "address_2": "APT. H",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276165248",
            "telephone_number": "919-931-3327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 W PARKVIEW DR",
            "address_2": "SUITE A",
            "city": "HENDERSON",
            "state": "NC",
            "postal_code": "275365958",
            "telephone_number": "252-572-2663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FAIN",
        "first_name": "SHANNON",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-24",
        "last_updated": "2013-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P007691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHANNON",
            "last_name": "JORDAN",
            "middle_name": "NICOLE",
            "credential": "LCSWA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Katharine Elizabeth Engler, LMFT
• Envision Healthcare, Inc. (Barker Road Group Home)
• Mohammad Ali Esmaeil Pour, MD
• Michael Lewis Evans
• Exceeding Expectation LLC
• Bobby Faison, LCAS
• Family Eye Center OD PA
• Family Foot & Ankle Center, PA
• Family Home Life, Inc
• Family Intervention & Prevention Services, LLC

• Clinical Social Worker in Henderson, NC
• Providers in Henderson, 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 Jun 24, 2013; 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.