Provider Demographics
NPI:1760648836
Name:SPENCER, SHANAN (LCPC)
Entity Type:Individual
Prefix:
First Name:SHANAN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5852
Mailing Address - Country:US
Mailing Address - Phone:301-791-3045
Mailing Address - Fax:240-313-3071
Practice Address - Street 1:150 PARK AVE
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-2218
Practice Address - Country:US
Practice Address - Phone:301-689-5034
Practice Address - Fax:301-689-5036
Is Sole Proprietor?:No
Enumeration Date:2008-07-29
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2763101YP2500X
TX86645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional