Individual
SHANNON THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
181 NEW RD STE 304, PARSIPPANY, NJ 07054-5625
(201) 389-9308
Mailing address
151 LAKE AVE, BOONTON, NJ 07005-1135
(201) 407-7047
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
37PC00896500
NJ
Other
Enumeration date
08/06/2021
Last updated
10/18/2022
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