Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Shannon Dexter Petrovich, LCSW, LISAC

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1104374255

Shannon Dexter Petrovich, LCSW, LISAC is a Clinical Social Worker in Tucson, Arizona. Qualified in 1988, 38 years ago. Practices with Aleph Center, PLLC, a 13-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Arizona.

Years since qualifying
38
Licensed in
AZ
In the registry since
2016
Specialties on file
2
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

5855 N Kolb Rd Unit 4208
Tucson, AZ 85750-0991
Phone: (520) 909-4740
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LCSW-4024 (AZ)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence LISAC-1365 (AZ)

Record details

NPI number1104374255
Entity typeIndividual (Type 1)
GenderFemale
Credentials LCSW , LISAC
Sole proprietorYes
NPI enumeratedSeptember 19, 2016
Last updated in NPPESSeptember 19, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1988 (38 years in practice)
Group practice Aleph Center, P.L.L.C. — 13 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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