Provider Demographics
NPI:1124356738
Name:MCCLARTY, SHANEKA L (LCPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANEKA
Middle Name:L
Last Name:MCCLARTY
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 1:2919 BURROWS LANE
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043
Mailing Address - Country:US
Mailing Address - Phone:678-871-9831
Mailing Address - Fax:404-592-6425
Practice Address - Street 1:2919 BURROWS LANE
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043
Practice Address - Country:US
Practice Address - Phone:678-871-9831
Practice Address - Fax:404-592-6425
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005789101YP2500X
MDLC7392101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional