Provider Demographics
NPI:1679042998
Name:HURLOCK, SHAKIA JEANETTE
Entity type:Individual
Prefix:
First Name:SHAKIA
Middle Name:JEANETTE
Last Name:HURLOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8805 PRISCILLA CT
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3540
Mailing Address - Country:US
Mailing Address - Phone:473-456-4698
Mailing Address - Fax:
Practice Address - Street 1:200 DOUGLAS ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1080
Practice Address - Country:US
Practice Address - Phone:347-456-4698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-15
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty