Provider Demographics
NPI:1952641334
Name:SHOLTIS, EMMA E (PSYD)
Entity Type:Individual
Prefix:
First Name:EMMA
Middle Name:E
Last Name:SHOLTIS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19801 PINEBARK WAY
Mailing Address - Street 2:
Mailing Address - City:BRINKLOW
Mailing Address - State:MD
Mailing Address - Zip Code:20862-9715
Mailing Address - Country:US
Mailing Address - Phone:216-513-0668
Mailing Address - Fax:
Practice Address - Street 1:707 CONSERVATION LN STE 300
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-2983
Practice Address - Country:US
Practice Address - Phone:240-801-5513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001041103T00000X
MD05498103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD589561800Medicaid