Provider Demographics
NPI:1730875493
Name:LEFTWICH, SHAWNTA (LGPC)
Entity type:Individual
Prefix:
First Name:SHAWNTA
Middle Name:
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 LANHAM HILL CIR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2697
Mailing Address - Country:US
Mailing Address - Phone:443-414-4249
Mailing Address - Fax:
Practice Address - Street 1:2616 LANHAM HILL CIR
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-2697
Practice Address - Country:US
Practice Address - Phone:443-414-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-14
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP13773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional