Provider Demographics
NPI:1952659328
Name:MARBLE, SHANNON ISAACS (LCPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:ISAACS
Last Name:MARBLE
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-9102
Mailing Address - Country:US
Mailing Address - Phone:443-340-1603
Mailing Address - Fax:
Practice Address - Street 1:106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION BRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21791-9102
Practice Address - Country:US
Practice Address - Phone:443-340-1603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-16
Last Update Date:2020-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MDLC5584101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselor