Basic Information
| Provider Information | |||||||||
| NPI: | 1467920199 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEDLESKI | ||||||||
| FirstName: | THERESA | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | LCPC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 2700 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676003984 | ||||||||
| FaxNumber: | 6676004065 | ||||||||
| Practice Location | |||||||||
| Address1: | 2700 WASHINGTON AVE | ||||||||
| Address2: | |||||||||
| City: | HALETHORPE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212273115 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6676003984 | ||||||||
| FaxNumber: | 6676004065 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/12/2018 | ||||||||
| LastUpdateDate: | 11/12/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | LC6544 | MD | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.