Provider Demographics
NPI:1982034229
Name:HYNSON, SHANETT (LPCMH)
Entity Type:Individual
Prefix:
First Name:SHANETT
Middle Name:
Last Name:HYNSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24210 GERMAN RD
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-7323
Mailing Address - Country:US
Mailing Address - Phone:302-272-3675
Mailing Address - Fax:
Practice Address - Street 1:24210 GERMAN RD
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-7323
Practice Address - Country:US
Practice Address - Phone:302-404-6840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-23
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PC-0000655101YP2500X
DEPC-0000655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty