Healthcare Provider Details

I. General information

NPI: 1760648836
Provider Name (Legal Business Name): SHANAN SPENCER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2008
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 PARK AVE
FROSTBURG MD
21532-2218
US

IV. Provider business mailing address

1180 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

V. Phone/Fax

Practice location:
  • Phone: 301-689-5034
  • Fax: 301-689-5036
Mailing address:
  • Phone: 301-791-3045
  • Fax: 240-313-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number86645
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number86645
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC2763
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: