Provider Demographics
NPI:1568071280
Name:RHOADS, SHANNON MAE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:MAE
Last Name:RHOADS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1416 LEXINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-8853
Mailing Address - Country:US
Mailing Address - Phone:610-996-0615
Mailing Address - Fax:
Practice Address - Street 1:825 EDEN RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4713
Practice Address - Country:US
Practice Address - Phone:717-462-7003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-28
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0209721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical