Provider Demographics
NPI:1609099654
Name:MISLAK, SHANA JANINE (MSW LCSW C CCDC)
Entity Type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:JANINE
Last Name:MISLAK
Suffix:
Gender:F
Credentials:MSW LCSW C CCDC
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:J
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:801 CHANCE CT
Mailing Address - Street 2:
Mailing Address - City:STREET
Mailing Address - State:MD
Mailing Address - Zip Code:21154
Mailing Address - Country:US
Mailing Address - Phone:410-893-7217
Mailing Address - Fax:410-893-7217
Practice Address - Street 1:801 CHANCE CT
Practice Address - Street 2:
Practice Address - City:STREET
Practice Address - State:MD
Practice Address - Zip Code:21154
Practice Address - Country:US
Practice Address - Phone:410-893-7217
Practice Address - Fax:410-893-7217
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1142CCDC101YA0400X
MD069601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQT87Medicare ID - Type Unspecified