Healthcare Provider Details

I. General information

NPI: 1588527691
Provider Name (Legal Business Name): REQUIEM COVE COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/07/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

IV. Provider business mailing address

5000 THAYER CTR STE C
OAKLAND MD
21550-1139
US

V. Phone/Fax

Practice location:
  • Phone: 410-357-1268
  • Fax:
Mailing address:
  • Phone: 410-357-1268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JADE SHAPIRO
Title or Position: THERAPIST/OWNER
Credential: MSW, LCSW-C
Phone: 410-357-1268