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NPI Code Detail

MEDICARE: SHANICE HACKLEY LCSW-C

MEDICARE: SHANICE HACKLEY LCSW-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041S0200XSchool Social Worker22031MD

General Provider Information

NPI Number : 1164980074
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHANICE HACKLEY LCSW-C
Provider Business Mailing Address
First Line : 10910 CLARKSVILLE PIKE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-6106
Country : US
Telephone Number : 410-313-6600
Fax Number :
Provider Business Practice Location Address
First Line : 10910 CLARKSVILLE PIKE
Second Line :
City : ELLICOTT CITY
State : MD
Zip : 21042-6106
Country : US
Telephone Number : 410-313-6600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2019
Last Update Date : 04/29/2026

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Directions to “ SHANICE HACKLEY LCSW-C” Practice Location

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