Provider Demographics
NPI:1568793685
Name:DUCKWORTH, SHELLY L (MS, LPC, CTS)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:L
Last Name:DUCKWORTH
Suffix:
Gender:F
Credentials:MS, LPC, CTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 W MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-2443
Mailing Address - Country:US
Mailing Address - Phone:717-337-9888
Mailing Address - Fax:
Practice Address - Street 1:450 W MIDDLE ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2443
Practice Address - Country:US
Practice Address - Phone:717-337-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC005417101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health