Provider Demographics
NPI:1861083107
Name:SHELL, ROBIN (LCPC)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SHELL
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 1:11412 KEDLESTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2019
Mailing Address - Country:US
Mailing Address - Phone:240-472-9919
Mailing Address - Fax:
Practice Address - Street 1:11412 KEDLESTON RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-2019
Practice Address - Country:US
Practice Address - Phone:240-472-9919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-29
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5186101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional