Provider Demographics
NPI:1407166176
Name:SHANKLIN, DAWN I (LMHC, LCPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:I
Last Name:SHANKLIN
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01602-3441
Mailing Address - Country:US
Mailing Address - Phone:508-767-3089
Mailing Address - Fax:
Practice Address - Street 1:737 W LOMBARD ST # 425
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1009
Practice Address - Country:US
Practice Address - Phone:410-746-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC15026101YM0800X
MA000009377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000009377OtherLMHC
MDLC15026OtherLCPC