Provider Demographics
NPI:1376383695
Name:MANNINO, SHANNON LEIGH (LPC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:LEIGH
Last Name:MANNINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1873 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-9721
Mailing Address - Country:US
Mailing Address - Phone:410-919-8047
Mailing Address - Fax:
Practice Address - Street 1:1873 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-9721
Practice Address - Country:US
Practice Address - Phone:410-919-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC017070101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional