Provider Demographics
NPI:1710643812
Name:SHAN, SALWA (LGMFT)
Entity Type:Individual
Prefix:
First Name:SALWA
Middle Name:
Last Name:SHAN
Suffix:
Gender:F
Credentials:LGMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8145 BALTIMORE AVE STE N487
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2491
Mailing Address - Country:US
Mailing Address - Phone:240-608-0110
Mailing Address - Fax:
Practice Address - Street 1:8145 BALTIMORE AVE STE N487
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-2491
Practice Address - Country:US
Practice Address - Phone:202-350-1882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-12
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGM858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist