Provider Demographics
NPI:1699271510
Name:SHINE, TONDA NICHELLE (LCPC)
Entity type:Individual
Prefix:
First Name:TONDA
Middle Name:NICHELLE
Last Name:SHINE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:TONDA
Other - Middle Name:NICHELLE
Other - Last Name:SHINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:16308 EASTHAM CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-3251
Mailing Address - Country:US
Mailing Address - Phone:215-668-5305
Mailing Address - Fax:
Practice Address - Street 1:16308 EASTHAM CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-3251
Practice Address - Country:US
Practice Address - Phone:215-668-5305
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC9444101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health