Provider Demographics
NPI:1669910824
Name:WARNICK, SHELLY (LCADC, LCPC)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:WARNICK
Suffix:
Gender:F
Credentials:LCADC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 312
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21501-0312
Mailing Address - Country:US
Mailing Address - Phone:301-697-4196
Mailing Address - Fax:
Practice Address - Street 1:31 BALTIMORE ST
Practice Address - Street 2:STE 108
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3091
Practice Address - Country:US
Practice Address - Phone:301-697-4196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCA2488101YA0400X
MDLC9535101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)