Provider Demographics
NPI:1750865796
Name:OGLESBY, SHINELLE (LCPC)
Entity Type:Individual
Prefix:
First Name:SHINELLE
Middle Name:
Last Name:OGLESBY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4617
Mailing Address - Country:US
Mailing Address - Phone:410-960-2496
Mailing Address - Fax:
Practice Address - Street 1:305 W CHESAPEAKE AVE STE 501
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-9936
Practice Address - Country:US
Practice Address - Phone:410-635-1146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-15
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9322101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health