Provider Demographics
NPI:1639941123
Name:WAKEFIELD, SHAQUIRA (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHAQUIRA
Middle Name:
Last Name:WAKEFIELD
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 1:19280 CIRCLE GATE DR APT 302
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-5223
Mailing Address - Country:US
Mailing Address - Phone:518-414-7297
Mailing Address - Fax:
Practice Address - Street 1:5510 CHEROKEE AVE STE 300
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2320
Practice Address - Country:US
Practice Address - Phone:240-650-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD229021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty