Provider Demographics
NPI:1891271979
Name:HOLMES, SHANNON O'BRIEN (LCMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:O'BRIEN
Last Name:HOLMES
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29626 OLD CREEK LN
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-7929
Mailing Address - Country:US
Mailing Address - Phone:301-331-1664
Mailing Address - Fax:
Practice Address - Street 1:29626 OLD CREEK LN
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-7929
Practice Address - Country:US
Practice Address - Phone:301-331-1664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2023-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRBT-18-56967106S00000X
MDLCM885106H00000X
MDLGM774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty