Provider Demographics
NPI:1245534288
Name:SHIVERS, JOANN ANITA (LCPC)
Entity type:Individual
Prefix:
First Name:JOANN
Middle Name:ANITA
Last Name:SHIVERS
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 1:2113 KOKO LN
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2925
Mailing Address - Country:US
Mailing Address - Phone:410-746-1184
Mailing Address - Fax:
Practice Address - Street 1:2113 KOKO LN
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2925
Practice Address - Country:US
Practice Address - Phone:410-746-1184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC3039101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional