Healthcare Provider Details

I. General information

NPI: 1013772664
Provider Name (Legal Business Name): MR. SHAWN M MCBRIDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: SHAWN MCBRIDE

II. Dates (important events)

Enumeration Date: 02/13/2024
Last Update Date: 02/13/2024
Certification Date: 02/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 MITCHELLVILLE RD STE 106
BOWIE MD
20716-1389
US

IV. Provider business mailing address

3060 MITCHELLVILLE RD STE 106
BOWIE MD
20716-1389
US

V. Phone/Fax

Practice location:
  • Phone: 301-615-4510
  • Fax:
Mailing address:
  • Phone: 301-615-4510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLGP13299
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: