Provider Demographics
NPI:1417728874
Name:SHANKLIN, ABRAHAM JR
Entity Type:Individual
Prefix:DR
First Name:ABRAHAM
Middle Name:
Last Name:SHANKLIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 ASHTON RD STE F
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MD
Mailing Address - Zip Code:21076-3157
Mailing Address - Country:US
Mailing Address - Phone:443-739-8314
Mailing Address - Fax:
Practice Address - Street 1:1331 ASHTON RD STE F
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MD
Practice Address - Zip Code:21076-3157
Practice Address - Country:US
Practice Address - Phone:443-739-8314
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-12
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22209101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral