Provider Demographics
NPI:1235894536
Name:LAVJONNE-BROWN, SHANNA LAHRAE
Entity type:Individual
Prefix:
First Name:SHANNA
Middle Name:LAHRAE
Last Name:LAVJONNE-BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 MORNING GLORY DR
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21629-2716
Mailing Address - Country:US
Mailing Address - Phone:443-421-7774
Mailing Address - Fax:
Practice Address - Street 1:21 BYTE CT STE G
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-8724
Practice Address - Country:US
Practice Address - Phone:301-846-7872
Practice Address - Fax:301-846-7973
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0653101YM0800X
MDLGP15377101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health