Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | LC2044 | MD |
NPI | 1003086786 |
---|---|
Provider Name | Mr. Jeff Shinal |
First Address | Leesburg, VA 20175 |
Second Address | Rockville, MD 20850-1714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2008 |
Last Update Date | 22/10/2014 |