Provider Demographics
NPI:1699001727
Name:SHANNON, DONNA (LCPC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:SHANNON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1055 TAYLOR AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-8317
Mailing Address - Country:US
Mailing Address - Phone:410-296-2004
Mailing Address - Fax:410-296-0094
Practice Address - Street 1:1055 TAYLOR AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8317
Practice Address - Country:US
Practice Address - Phone:410-296-2004
Practice Address - Fax:410-296-0094
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2971101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral