Provider Demographics
NPI:1336709856
Name:JONES, SHANA CORRINE (LGPC)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:CORRINE
Last Name:JONES
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 1:703 TULIP CT
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:21040-2426
Mailing Address - Country:US
Mailing Address - Phone:443-655-6227
Mailing Address - Fax:
Practice Address - Street 1:3454 ELLICOTT CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4130
Practice Address - Country:US
Practice Address - Phone:443-655-6227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty