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General NPI Number Information
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NPI Number | 1629672936
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Entity Type | Individual
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Provider Name | SHAE R TRAVIS LCPC
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Gender | Female
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Dates
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Enumeration Date | 11/27/2020
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Last Update Date | 12/06/2024
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Provider Practice Location Address
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Address Line | 120 WATERFRONT ST #2300 STE 420
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City | NATIONAL HARBOR
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State | MD
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Zip | 20745-1122
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Country | US
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Telephone | 301-778-8566
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Fax |
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Provider Business Mailing Address
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Address Line | 120 WATERFRONT ST #2300 STE 420
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City | NATIONAL HARBOR
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State | MD
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Zip | 20745-1122
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Country | US
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Telephone | 301-778-8566
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | PRC200001564
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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 | LC12935
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License Number State | MD
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