Provider Demographics
NPI:1518428762
Name:SHEELER, SHELLEY (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:SHEELER
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:
Other - Last Name:SHEELER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:1554 MARCO DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-4842
Mailing Address - Country:US
Mailing Address - Phone:443-672-8404
Mailing Address - Fax:
Practice Address - Street 1:711 WISE AVE
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-5028
Practice Address - Country:US
Practice Address - Phone:443-530-6533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD246911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD24691OtherLCSW-C