Provider Demographics
NPI:1629672936
Name:TRAVIS, SHAE R (LCPC)
Entity type:Individual
Prefix:
First Name:SHAE
Middle Name:R
Last Name:TRAVIS
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 1:120 WATERFRONT ST #2300
Mailing Address - Street 2:STE 420
Mailing Address - City:NATIONAL HARBOR
Mailing Address - State:MD
Mailing Address - Zip Code:20745-1122
Mailing Address - Country:US
Mailing Address - Phone:301-778-8566
Mailing Address - Fax:
Practice Address - Street 1:120 WATERFRONT ST #2300
Practice Address - Street 2:STE 420
Practice Address - City:NATIONAL HARBOR
Practice Address - State:MD
Practice Address - Zip Code:20745-1122
Practice Address - Country:US
Practice Address - Phone:301-778-8566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC200001564101YP2500X
MDLC12935101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional