Provider Demographics
NPI:1427401199
Name:EVERING, SHANNA (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:
Last Name:EVERING
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 1:10715 CHARTER DR STE 130
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2892
Mailing Address - Country:US
Mailing Address - Phone:443-653-1363
Mailing Address - Fax:410-367-2000
Practice Address - Street 1:10715 CHARTER DR STE 130
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2892
Practice Address - Country:US
Practice Address - Phone:443-653-1363
Practice Address - Fax:410-367-2000
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-19
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3763101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional