Provider Demographics
NPI:1134786023
Name:BERNARD, SHANICE (LCPC)
Entity type:Individual
Prefix:
First Name:SHANICE
Middle Name:
Last Name:BERNARD
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 1:6505 SIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-9714
Mailing Address - Country:US
Mailing Address - Phone:850-499-6723
Mailing Address - Fax:
Practice Address - Street 1:7520 STANDISH PL STE 190
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20855-2847
Practice Address - Country:US
Practice Address - Phone:301-525-2029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-25
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9562101Y00000X
MDLC11404101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor