Provider Demographics
NPI:1205679313
Name:LEE, SHANNON (LGPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:LEE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13106 SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3337
Mailing Address - Country:US
Mailing Address - Phone:301-748-9176
Mailing Address - Fax:
Practice Address - Street 1:3600 CLIPPER MILL RD STE 340
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1995
Practice Address - Country:US
Practice Address - Phone:443-990-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC200001689101YP2500X
MDLGP15092101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional