Provider Demographics
NPI:1659097723
Name:WOODS, SHANNON RENEE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RENEE
Last Name:WOODS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 SIMMERS RD
Mailing Address - Street 2:
Mailing Address - City:RISING SUN
Mailing Address - State:MD
Mailing Address - Zip Code:21911-2304
Mailing Address - Country:US
Mailing Address - Phone:443-907-2558
Mailing Address - Fax:
Practice Address - Street 1:47 SIMMERS RD
Practice Address - Street 2:
Practice Address - City:RISING SUN
Practice Address - State:MD
Practice Address - Zip Code:21911-2304
Practice Address - Country:US
Practice Address - Phone:443-907-2558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD200661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical