Provider Demographics
NPI:1407064397
Name:RYKIEL, SHAUNA MICHELLE (LCSW-C, LCADC)
Entity Type:Individual
Prefix:MRS
First Name:SHAUNA
Middle Name:MICHELLE
Last Name:RYKIEL
Suffix:
Gender:F
Credentials:LCSW-C, LCADC
Other - Prefix:MISS
Other - First Name:SHAUNA
Other - Middle Name:MICHELLE
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1012
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-8012
Mailing Address - Country:US
Mailing Address - Phone:410-975-0067
Mailing Address - Fax:410-975-0204
Practice Address - Street 1:570 RITCHIE HWY # H
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2925
Practice Address - Country:US
Practice Address - Phone:410-975-0067
Practice Address - Fax:410-975-0204
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA424101YA0400X
MD123801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD11340840OtherCAQH PROVIDER NUMBER