Provider Demographics
NPI:1760937254
Name:CLAY, SHANELLE (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:SHANELLE
Middle Name:
Last Name:CLAY
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 WARFIELD DR APT A3009
Mailing Address - Street 2:411 WARFIELD DR.
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-5524
Mailing Address - Country:US
Mailing Address - Phone:202-460-9455
Mailing Address - Fax:
Practice Address - Street 1:1420 COLUMBIA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-4779
Practice Address - Country:US
Practice Address - Phone:202-400-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC14781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional