Provider Demographics
NPI:1649743105
Name:MOHNKERN, SHELLY M (LCPC)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:M
Last Name:MOHNKERN
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 1:20632 ANNDYKE WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-2804
Mailing Address - Country:US
Mailing Address - Phone:240-418-8377
Mailing Address - Fax:301-528-4315
Practice Address - Street 1:20632 ANNDYKE WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874
Practice Address - Country:US
Practice Address - Phone:240-418-8377
Practice Address - Fax:301-528-4315
Is Sole Proprietor?:No
Enumeration Date:2019-01-08
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP8841101Y00000X
MDLC10679101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD327612SM1Medicaid