Provider Demographics
NPI:1891099040
Name:HARLOW, SHELLY MCCOMAS (CSC-AD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MCCOMAS
Last Name:HARLOW
Suffix:
Gender:F
Credentials:CSC-AD
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:WHEELER
Other - Last Name:MCCOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5517 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3457
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-235-8807
Practice Address - Street 1:5517 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225-3457
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:410-235-8807
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDSC0357101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)