Healthcare Provider Details

I. General information

NPI: 1629857800
Provider Name (Legal Business Name): SHIRE COUNSELING AND COACHING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2023
Last Update Date: 09/26/2023
Certification Date: 09/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

IV. Provider business mailing address

1140 PROFESSIONAL CT
HAGERSTOWN MD
21740-5852
US

V. Phone/Fax

Practice location:
  • Phone: 240-520-8712
  • Fax: 301-778-5200
Mailing address:
  • Phone: 240-520-8712
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: TIFFANY LYN SHAW
Title or Position: OWNER
Credential: LCSW-C
Phone: 240-520-8712