Individual
AMELIA D SHANNON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
239 COLUMBUS AVE, NEW HAVEN, CT 06519-2230
(203) 910-0548
Mailing address
239 COLUMBUS AVE, NEW HAVEN, CT 06519
(203) 910-0548
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3602
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3602
—
CT
Enumeration date
10/31/2018
Last updated
10/31/2018
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