Provider Demographics
NPI:1215523352
Name:SHELTON-SOWARD, LONNA MARGARET (LGPC)
Entity type:Individual
Prefix:
First Name:LONNA
Middle Name:MARGARET
Last Name:SHELTON-SOWARD
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 PENWICK CIR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-5106
Mailing Address - Country:US
Mailing Address - Phone:202-486-6122
Mailing Address - Fax:
Practice Address - Street 1:1707 ROSEMONT AVE
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4135
Practice Address - Country:US
Practice Address - Phone:202-486-6122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-13
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP10166101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDLGP10166OtherMENTAL HEALTH COUNSELING