Provider Demographics
NPI:1376321802
Name:MCCALLUM-COPPAGE, SHANIKA (LCPC, NCC)
Entity type:Individual
Prefix:MS
First Name:SHANIKA
Middle Name:
Last Name:MCCALLUM-COPPAGE
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:SHANIKA
Other - Middle Name:
Other - Last Name:COPPAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 767
Mailing Address - Street 2:
Mailing Address - City:NORTH EAST
Mailing Address - State:MD
Mailing Address - Zip Code:21901-0767
Mailing Address - Country:US
Mailing Address - Phone:443-722-0249
Mailing Address - Fax:410-275-3551
Practice Address - Street 1:4690 MILLENNIUM DR STE 300
Practice Address - Street 2:
Practice Address - City:BELCAMP
Practice Address - State:MD
Practice Address - Zip Code:21017-1527
Practice Address - Country:US
Practice Address - Phone:443-722-0249
Practice Address - Fax:410-275-3551
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2025-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0011930101YP2500X
MDLC16719101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3001831600Medicaid
MD335757100Medicaid