Provider Demographics
NPI:1851998694
Name:RANDALL, SHANICE MONIQUE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:MONIQUE
Last Name:RANDALL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14202 WATER FOWL WAY
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-4002
Mailing Address - Country:US
Mailing Address - Phone:301-257-6282
Mailing Address - Fax:
Practice Address - Street 1:14202 WATER FOWL WAY
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-4002
Practice Address - Country:US
Practice Address - Phone:301-257-6282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23077104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker