Healthcare Provider Details

I. General information

NPI: 1134272941
Provider Name (Legal Business Name): SHANON MARIE MOYER LPCMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32630 CEDAR DR UNIT A
MILLVILLE DE
19967-6946
US

IV. Provider business mailing address

32630 CEDAR DR UNIT A
MILLVILLE DE
19967-6946
US

V. Phone/Fax

Practice location:
  • Phone: 302-420-8846
  • Fax:
Mailing address:
  • Phone: 302-420-8846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC7299
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC-0000480
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: