Provider Demographics
NPI:1770068272
Name:SHIELDS, MICHELINE CHRISTINA (LCPC)
Entity type:Individual
Prefix:
First Name:MICHELINE
Middle Name:CHRISTINA
Last Name:SHIELDS
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 1:7310 RITCHIE HWY STE 1009
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-3398
Mailing Address - Country:US
Mailing Address - Phone:410-768-5988
Mailing Address - Fax:410-768-5989
Practice Address - Street 1:7310 RITCHIE HWY STE 1009
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-3398
Practice Address - Country:US
Practice Address - Phone:410-768-5988
Practice Address - Fax:410-768-5989
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional