Provider Demographics
NPI:1861037145
Name:SHORTS, SHANICE NICOLE (LGSW)
Entity Type:Individual
Prefix:
First Name:SHANICE
Middle Name:NICOLE
Last Name:SHORTS
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5583 HARRINGTON FALLS LN UNIT 1279
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-4004
Mailing Address - Country:US
Mailing Address - Phone:940-642-4712
Mailing Address - Fax:
Practice Address - Street 1:1707B KALORAMA RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2623
Practice Address - Country:US
Practice Address - Phone:202-851-3671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-11
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG50082715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health