Provider Demographics
NPI:1588833719
Name:COLE, SHEMICA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHEMICA
Middle Name:
Last Name:COLE
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 1:4623 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4914
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:7000 SECURITY BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21244-2561
Practice Address - Country:US
Practice Address - Phone:410-281-1334
Practice Address - Fax:410-298-4326
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
421014OtherTRICARE/MHN
900494-334OtherMAGELLAN
T541-0094OtherCAREFIRST BCBS
MD016535200Medicaid
93275501OtherCAREFIRST BCBS
T541-0094OtherCAREFIRST BCBS