Provider Demographics
NPI:1558503748
Name:OWENS, SHANDA J (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:J
Last Name:OWENS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2604 WENTWORTH RD
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-6228
Mailing Address - Country:US
Mailing Address - Phone:443-814-5156
Mailing Address - Fax:
Practice Address - Street 1:1634 SULPHUR SPRING RD
Practice Address - Street 2:
Practice Address - City:HALETHORPE
Practice Address - State:MD
Practice Address - Zip Code:21227-2539
Practice Address - Country:US
Practice Address - Phone:410-242-0920
Practice Address - Fax:410-242-0924
Is Sole Proprietor?:No
Enumeration Date:2009-04-02
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical