Provider Demographics
NPI:1952650657
Name:GLAUDE, SHANI
Entity Type:Individual
Prefix:
First Name:SHANI
Middle Name:
Last Name:GLAUDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20004 FREDERICK RD
Mailing Address - Street 2:33
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-4074
Mailing Address - Country:US
Mailing Address - Phone:240-893-2763
Mailing Address - Fax:
Practice Address - Street 1:20528 BOLAND FARM RD
Practice Address - Street 2:207
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4021
Practice Address - Country:US
Practice Address - Phone:301-569-6326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP4593101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional