Provider Demographics
NPI:1043869399
Name:MCCOMB, SHAWNITA
Entity Type:Individual
Prefix:
First Name:SHAWNITA
Middle Name:
Last Name:MCCOMB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 STRETFORD WAY APT 205
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5949
Mailing Address - Country:US
Mailing Address - Phone:202-421-5333
Mailing Address - Fax:
Practice Address - Street 1:1801 COLUMBIA RD NW STE 102
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2031
Practice Address - Country:US
Practice Address - Phone:202-506-3240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLGPC00673101YP2500X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician