1992136592 NPI number — MRS. ITSELDA MARIA SHAND-GAINES LPC, LCPC

Table of content: MRS. ITSELDA MARIA SHAND-GAINES LPC, LCPC (NPI 1992136592)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992136592 NPI number — MRS. ITSELDA MARIA SHAND-GAINES LPC, LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAND-GAINES
Provider First Name:
ITSELDA
Provider Middle Name:
MARIA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAND
Provider Other First Name:
ITSELDA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC, LCPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992136592
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15600 TAYLERTON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDYWINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20613-3812
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-922-7525
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 K ST, NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-835-0680
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  PRC14308 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LC5385 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LC5385 . This is a "STATE LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PRC14308 . This is a "DISTRICT OF COLUMBIA LICENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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