Provider Demographics
NPI:1982037156
Name:HEARD, SHALENA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHALENA
Middle Name:L
Last Name:HEARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11400 GLENN DALE BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9049
Mailing Address - Country:US
Mailing Address - Phone:301-352-0320
Mailing Address - Fax:
Practice Address - Street 1:11400 GLENN DALE BLVD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9049
Practice Address - Country:US
Practice Address - Phone:301-352-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-12
Last Update Date:2016-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05613103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist