Provider Demographics
NPI:1043469430
Name:CONNALLY, SHARILYN DENISE (LGPC)
Entity type:Individual
Prefix:MRS
First Name:SHARILYN
Middle Name:DENISE
Last Name:CONNALLY
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 SAND WEDGE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-7965
Mailing Address - Country:US
Mailing Address - Phone:240-244-1787
Mailing Address - Fax:
Practice Address - Street 1:9320 ANNAPOLIS RD STE 100
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3122
Practice Address - Country:US
Practice Address - Phone:301-577-8152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP294101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional