Provider Demographics
NPI:1205534377
Name:CORDOBA, SHALAIYAH (LCMFT)
Entity type:Individual
Prefix:
First Name:SHALAIYAH
Middle Name:
Last Name:CORDOBA
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:916 PHILLIP POWERS DR
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-3517
Mailing Address - Country:US
Mailing Address - Phone:443-561-6139
Mailing Address - Fax:
Practice Address - Street 1:916 PHILLIP POWERS DR
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3517
Practice Address - Country:US
Practice Address - Phone:443-561-6139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM1085106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist