Provider Demographics
NPI:1477212710
Name:MOORE, SHAYNA (LGPC)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:MOORE
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 FIELDSTEAD CT APT H
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5214
Mailing Address - Country:US
Mailing Address - Phone:848-250-4050
Mailing Address - Fax:
Practice Address - Street 1:2227 OLD EMMORTON RD STE 115
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-6190
Practice Address - Country:US
Practice Address - Phone:410-589-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP12108101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor