Provider Demographics
NPI:1093072290
Name:STITT, SHIRLEY M (LCPC)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:M
Last Name:STITT
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 1:2108 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5709
Mailing Address - Country:US
Mailing Address - Phone:410-889-2300
Mailing Address - Fax:
Practice Address - Street 1:4401 ROLAND AVE
Practice Address - Street 2:UNIT #111
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2729
Practice Address - Country:US
Practice Address - Phone:410-804-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional