Provider Demographics
NPI:1053534909
Name:ALDRIDGE-SMITH, SHANNON ELLISON (LPC, MHSP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ELLISON
Last Name:ALDRIDGE-SMITH
Suffix:
Gender:F
Credentials:LPC, MHSP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:ELLISON
Other - Last Name:ALDRIDGE-REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, MHSP
Mailing Address - Street 1:8748 RASPBERRY LN
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38016-3502
Mailing Address - Country:US
Mailing Address - Phone:901-752-5679
Mailing Address - Fax:
Practice Address - Street 1:2262 S GERMANTOWN RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3805
Practice Address - Country:US
Practice Address - Phone:901-753-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000001856101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health