Healthcare Provider Details

I. General information

NPI: 1235894536
Provider Name (Legal Business Name): MRS. SHANNA LAHRAE LAVJONNE-BROWN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2021
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 LOG CANOE CIR
STEVENSVILLE MD
21666-2127
US

IV. Provider business mailing address

108 MORNING GLORY DR
DENTON MD
21629-2716
US

V. Phone/Fax

Practice location:
  • Phone: 410-604-0226
  • Fax:
Mailing address:
  • Phone: 443-421-7774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC17812
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA0653
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: