Healthcare Provider Details

I. General information

NPI: 1992136592
Provider Name (Legal Business Name): ITSELDA MARIA SHAND-GAINES LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ITSELDA SHAND LPC, LCPC

II. Dates (important events)

Enumeration Date: 12/06/2013
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1629 K ST, NW
WASHINTON DC
20006
US

IV. Provider business mailing address

15600 TAYLERTON LN
BRANDYWINE MD
20613-3812
US

V. Phone/Fax

Practice location:
  • Phone: 202-835-0680
  • Fax:
Mailing address:
  • Phone: 301-922-7525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPRC14308
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5385
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: