Provider Demographics
NPI:1164088258
Name:CARROLL, SHELIA M (PHD, LP)
Entity Type:Individual
Prefix:
First Name:SHELIA
Middle Name:M
Last Name:CARROLL
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3934 EMBLEM COR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3223
Mailing Address - Country:US
Mailing Address - Phone:240-383-7974
Mailing Address - Fax:301-577-4123
Practice Address - Street 1:8240 PROFESSIONAL PL STE 200
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-2215
Practice Address - Country:US
Practice Address - Phone:301-577-4470
Practice Address - Fax:301-577-4123
Is Sole Proprietor?:No
Enumeration Date:2019-05-14
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04015103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist