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General NPI Number Information
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NPI Number | 1376321802
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Entity Type | Individual
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Provider Name | SHANIKA MCCALLUM-COPPAGE LCPC, NCC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2023
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Last Update Date | 10/12/2025
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Provider Practice Location Address
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Address Line | 4690 MILLENNIUM DR STE 300
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City | BELCAMP
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State | MD
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Zip | 21017-1527
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Country | US
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Telephone | 443-722-0249
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Fax | 410-275-3551
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Provider Business Mailing Address
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Address Line | PO BOX 767
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City | NORTH EAST
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State | MD
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Zip | 21901-0767
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Country | US
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Telephone | 443-722-0249
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Fax | 410-275-3551
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PC-0011930
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LC16719
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License Number State | MD
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