Provider Demographics
NPI:1407234115
Name:LOVE, SHANNON CORCORAN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SHANNON
Middle Name:CORCORAN
Last Name:LOVE
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 1:463 SHORE ACRES RD APT 2A
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MD
Mailing Address - Zip Code:21012-1920
Mailing Address - Country:US
Mailing Address - Phone:443-254-6501
Mailing Address - Fax:
Practice Address - Street 1:463 SHORE ACRES RD APT 2A
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:MD
Practice Address - Zip Code:21012-1920
Practice Address - Country:US
Practice Address - Phone:443-254-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-13
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6324101YM0800X
MDLC8641101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health