MEDICARE: SHEA PINES LGMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	0717002491	VA
2	106H00000X	Marriage & Family Therapist	LCM1132	MD

General Provider Information

NPI Number	:	1326822990
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEA PINES LGMFT

Provider Business Mailing Address
First Line	:	6431 MAJESTIC WAY
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23231-5270
Country	:	US
Telephone Number	:	832-885-7956
Fax Number	:

Provider Business Practice Location Address
First Line	:	267 KENTLANDS BLVD # 4071
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20878-5446
Country	:	US
Telephone Number	:	832-885-7956
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2023
Last Update Date	:	04/21/2026

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Directions to “ SHEA PINES LGMFT” Practice Location

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