Provider Demographics
NPI:1639492457
Name:MORRIS, SHIRLEY R (MA)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:R
Last Name:MORRIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10109 THRIFT RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3764
Mailing Address - Country:US
Mailing Address - Phone:301-787-2761
Mailing Address - Fax:301-868-0528
Practice Address - Street 1:10506 THRIFT RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3734
Practice Address - Country:US
Practice Address - Phone:301-787-2761
Practice Address - Fax:301-868-0528
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-08
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0420101YA0400X
MDLC1468101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)