Provider Demographics
NPI:1679397897
Name:JONES, SHANZET A (LGPC)
Entity type:Individual
Prefix:MRS
First Name:SHANZET
Middle Name:A
Last Name:JONES
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 1:14 TROUT RUN RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-3065
Mailing Address - Country:US
Mailing Address - Phone:443-529-4509
Mailing Address - Fax:
Practice Address - Street 1:14 TROUT RUN RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21220-3065
Practice Address - Country:US
Practice Address - Phone:443-529-4509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-13
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLGP15907101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty