Provider Demographics
NPI:1538292909
Name:MOTLEY-SHANNON, KESI JAPERA (LGSW)
Entity Type:Individual
Prefix:
First Name:KESI
Middle Name:JAPERA
Last Name:MOTLEY-SHANNON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 ROMIG DR
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-2051
Mailing Address - Country:US
Mailing Address - Phone:410-729-2135
Mailing Address - Fax:
Practice Address - Street 1:15 ROMIG DR
Practice Address - Street 2:
Practice Address - City:CROWNSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21032-2051
Practice Address - Country:US
Practice Address - Phone:410-729-2135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG107061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical