Provider Demographics
NPI:1114783446
Name:ECKERT, SHANNON LEIGH (MS, LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:ECKERT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WILLEVER RD
Mailing Address - Street 2:
Mailing Address - City:ASBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08802-1161
Mailing Address - Country:US
Mailing Address - Phone:215-350-5348
Mailing Address - Fax:
Practice Address - Street 1:2 HIDDEN LN
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4603
Practice Address - Country:US
Practice Address - Phone:267-209-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC014204101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health