Provider Demographics
NPI:1821562190
Name:FENYO, SHAWNTAY THERESA (LCPC)
Entity Type:Individual
Prefix:
First Name:SHAWNTAY
Middle Name:THERESA
Last Name:FENYO
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 1:634 RIDEN ST
Mailing Address - Street 2:
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113-1726
Mailing Address - Country:US
Mailing Address - Phone:443-303-7404
Mailing Address - Fax:
Practice Address - Street 1:1177 ANNAPOLIS RD UNIT 118
Practice Address - Street 2:
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113-7505
Practice Address - Country:US
Practice Address - Phone:443-962-2479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-19
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLC10414101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health