Provider Demographics
NPI: | 1700437720 |
---|---|
Name: | SHIM CHOW MIN, LORENA CHARMAINE (LCPC) |
Entity Type: | Individual |
Prefix: | |
First Name: | LORENA |
Middle Name: | CHARMAINE |
Last Name: | SHIM CHOW MIN |
Suffix: | |
Gender: | F |
Credentials: | LCPC |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 219 MERLIN DR |
Mailing Address - Street 2: | |
Mailing Address - City: | BELCAMP |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21017-1539 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-486-0602 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1407 LOCHNER RD STE 0 |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21239-2932 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-486-0602 |
Practice Address - Fax: | |
Is Sole Proprietor?: | No |
Enumeration Date: | 2019-09-20 |
Last Update Date: | 2019-09-20 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 101YA0400X | |
MD | LC4382 | 101YM0800X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MD | LC4382 | Other | LICENSED PROFESSIONAL COUNSELOR NUMBER |