Healthcare Provider Details

I. General information

NPI: 1821437559
Provider Name (Legal Business Name): SHANNTEL MONIQUE GLADNEY LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2013
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 FITCH AVE
NOTTINGHAM MD
21236-3927
US

IV. Provider business mailing address

1800 N CHARLES ST
BALTIMORE MD
21201-5920
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-8755
  • Fax: 410-871-8120
Mailing address:
  • Phone: 443-388-9654
  • Fax: 443-388-9367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC5034
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: