Provider Demographics
NPI:1093367096
Name:BIRKNER, SHANNON RAE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RAE
Last Name:BIRKNER
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 4TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-1907
Mailing Address - Country:US
Mailing Address - Phone:908-403-5465
Mailing Address - Fax:
Practice Address - Street 1:5695 KING CENTRE DR STE B101
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5747
Practice Address - Country:US
Practice Address - Phone:703-680-9527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health