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General NPI Number Information
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NPI Number | 1073322558
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Entity Type | Individual
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Provider Name | DAESEONG SHIN LCPC
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Gender | Male
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Dates
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Enumeration Date | 12/30/2024
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Last Update Date | 01/02/2025
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Provider Practice Location Address
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Address Line | 429 INGRAM CT
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City | GLEN BURNIE
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State | MD
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Zip | 21061-6125
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Country | US
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Telephone | 443-585-8167
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Fax |
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Provider Business Mailing Address
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Address Line | 429 INGRAM CT
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City | GLEN BURNIE
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State | MD
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Zip | 21061-6125
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Country | US
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Telephone | 443-585-8167
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | LC14961
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License Number State | MD
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