Provider Demographics
NPI:1821467614
Name:MCGEE, SHANNON HERZOG (LPC)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:HERZOG
Last Name:MCGEE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6901 S VAN DORN ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3961
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6901 S VAN DORN ST
Practice Address - Street 2:
Practice Address - City:KINGSTOWNE
Practice Address - State:VA
Practice Address - Zip Code:22315-3961
Practice Address - Country:US
Practice Address - Phone:703-313-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2015-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional