Provider Demographics
NPI:1689122020
Name:FRITZ, SHANNON (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FRITZ
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9721 STARLING RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1776
Mailing Address - Country:US
Mailing Address - Phone:443-865-7840
Mailing Address - Fax:
Practice Address - Street 1:2 W. ROLLING CROSSROADS
Practice Address - Street 2:SUITE 209
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-6209
Practice Address - Country:US
Practice Address - Phone:443-865-7840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6983101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional