Individual
MRS. MARILE YVONNE SHACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LGPC
Contact information
Practice address
1620 ELTON RD STE 204, SILVER SPRING, MD 20903-1760
(301) 439-7191
Mailing address
6012 WESTBROOK DR, NEW CARROLLTON, MD 20784-2909
(240) 898-0384
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
LGP098
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LGP098
PROFESSIONAL COUNSELOR
MD
Enumeration date
05/02/2007
Last updated
07/08/2007
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