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General NPI Number Information
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NPI Number | 1366806184
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Entity Type | Organization
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Legal Business Name | SHONA WELLNESS GROUP LLC
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Dates
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Enumeration Date | 04/07/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 1030 KEARNY ST NE
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City | WASHINGTON
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State | DC
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Zip | 20017-3518
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Country | US
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Telephone | 202-431-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 6621 HIGHGATE DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-1002
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Country | US
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Telephone | 202-431-1682
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | LISA C CAMPBELL
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Credential | LICSW
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Telephone | 202-431-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 200-1064
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License Number State | DC
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC293
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC50080073
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License Number State | DC
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