Healthcare Provider Details

I. General information

NPI: 1073417556
Provider Name (Legal Business Name): SHAYLA KING LGPC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1916 STONE CASTLE DR
SEVERN MD
21144-1461
US

IV. Provider business mailing address

1916 STONE CASTLE DR
SEVERN MD
21144-1461
US

V. Phone/Fax

Practice location:
  • Phone: 443-422-8623
  • Fax:
Mailing address:
  • Phone: 443-422-8623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLGP18652
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: