Provider Demographics
NPI:1164562278
Name:HOWARD, SHANNON
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:HOWARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10665 STANHAVEN PL STE 3119
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3055
Mailing Address - Country:US
Mailing Address - Phone:240-448-3711
Mailing Address - Fax:240-607-6702
Practice Address - Street 1:10665 STANHAVEN PL STE 3119
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3055
Practice Address - Country:US
Practice Address - Phone:240-448-3711
Practice Address - Fax:240-607-6702
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1508101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD624LMedicare ID - Type Unspecified