Provider Demographics
NPI:1083971634
Name:LEARN, SHANNA (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:LEARN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2646
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08260-8646
Mailing Address - Country:US
Mailing Address - Phone:814-504-3514
Mailing Address - Fax:
Practice Address - Street 1:2409 CENTRAL AVE
Practice Address - Street 2:APT. 208
Practice Address - City:WILDWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08260-5232
Practice Address - Country:US
Practice Address - Phone:814-504-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-20
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00448800101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist