Healthcare Provider Details

I. General information

NPI: 1629678107
Provider Name (Legal Business Name): SHAMONIQUE DRISKELL LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2020
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date: 06/22/2026
Reactivation Date: 08/24/2026

III. Provider practice location address

220 REFINING DR
BROOKLYN MD
21225-3100
US

IV. Provider business mailing address

220 REFINING DR
BROOKLYN MD
21225-3100
US

V. Phone/Fax

Practice location:
  • Phone: 240-380-6229
  • Fax:
Mailing address:
  • Phone: 240-380-6229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC6423
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: