Shannon Gabrielle Bennett, ADT
Individual provider Active NPI Addiction (Substance Use Disorder) Counselor · Lavale, MD
NPI 1104679745 · NPPES record last updated Apr 11, 2024
Key facts
- NPI
- 1104679745
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Addiction (Substance Use Disorder) Counselor 101YA0400X
- License
- 3502 (MD)
- Practice address
- 14701 National Hwy SW Ste 5&6
Lavale, MD 21502-6573 - Phone
- (866) 922-1856
- NPI assigned
- Apr 11, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3502 | MD | MD | Addiction (Substance Use Disorder) Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 3502 | MD | Yes |
Addresses
Primary practice location
14701 National Hwy SW Ste 5&6
Lavale, MD 21502-6573
Mailing address
14701 National Hwy SW Ste 5&6
Lavale, MD 21502-6573
Phone (866) 922-1856
Other providers in Lavale, MD
- Abby Nichole Barnes
- Aaron Barth
- Bechter Chiropractic PC
- Robert J Bechter
- Matthew J Beeman
- Janice Irene Blough-Labuda
- David Allen Bohn
- Anthony Joseph Bollino Jr.
- Eliette Yadira Bouie
- Larry Bowling
All providers in Lavale, MD · Addiction (Substance Use Disorder) Counselor in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 11, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.