Provider Demographics
NPI:1932543063
Name:BRANCH, SHELITA RACHEL
Entity Type:Individual
Prefix:
First Name:SHELITA
Middle Name:RACHEL
Last Name:BRANCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHELITA
Other - Middle Name:RACHEL
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LGPC
Mailing Address - Street 1:4475 REGENCY PL
Mailing Address - Street 2:SUITE 205
Mailing Address - City:WHITE PLAINS
Mailing Address - State:MD
Mailing Address - Zip Code:20695-3072
Mailing Address - Country:US
Mailing Address - Phone:240-427-3554
Mailing Address - Fax:
Practice Address - Street 1:4475 REGENCY PL
Practice Address - Street 2:SUITE 205
Practice Address - City:WHITE PLAINS
Practice Address - State:MD
Practice Address - Zip Code:20695-3072
Practice Address - Country:US
Practice Address - Phone:240-427-3554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP4583101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional