=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326857004
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANCORA COUNSELING & WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2025
-----------------------------------------------------
Last Update Date | 06/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24 STEELE AVE
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-991-3651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24 STEELE AVE
-----------------------------------------------------
City | ANNAPOLIS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21401-2807
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-991-3651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOTHERAPIST
-----------------------------------------------------
Name | SHANNON SHIFFLETT
-----------------------------------------------------
Credential | LCSW-C
-----------------------------------------------------
Telephone | 410-991-3651
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------