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Individual

KATIE LYNN SHANNON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LCAT, LCPC, LPC

Contact information

Practice address
919 WINTON RD S STE 316, ROCHESTER, NY 14618-1633
(315) 681-7958
Mailing address
6 LOMBARD ST APT 1, SOUTH PORTLAND, ME 04106-5703
(315) 681-7958

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
CC6353
ME
101YP2500X
Professional Counselor
LPC.0016675
CO
221700000X
Art Therapist
Primary
002452
NY

Other

Enumeration date
11/11/2020
Last updated
02/13/2023
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