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General NPI Number Information
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NPI Number | 1962388942
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Entity Type | Organization
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Legal Business Name | SHALAIYAH D CORDOBA
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Dates
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Enumeration Date | 08/14/2025
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Last Update Date | 08/14/2025
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Provider Practice Location Address
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Address Line | 916 PHILLIP POWERS DR
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City | LAUREL
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State | MD
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Zip | 20707-3517
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Country | US
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Telephone | 443-561-6139
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Fax |
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Provider Business Mailing Address
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Address Line | 916 PHILLIP POWERS DR
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City | LAUREL
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State | MD
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Zip | 20707-3517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHALAIYAH CORDOBA
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Credential | LCMFT
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Telephone | 443-561-6139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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