Healthcare Provider Details

I. General information

NPI: 1730728924
Provider Name (Legal Business Name): GABRIELLE SHIRDON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/06/2020
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 CLOVER DR
LITTLESTOWN PA
17340-9175
US

IV. Provider business mailing address

18 CLOVER DR
LITTLESTOWN PA
17340-9175
US

V. Phone/Fax

Practice location:
  • Phone: 717-956-6649
  • Fax:
Mailing address:
  • Phone: 717-965-6649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLC10243
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC012073
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: