Active NPI
Kimberley Shepard-El-Ince
- Mental Health Counselor
- Takoma Park, MD
National Provider Identifier
1215650015
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- LGP13052
- Practice address
- 6930 Carroll Ave Ste 610
Takoma Park, MD 20912-4498 - Phone
- (301) 563-9156
- NPI assigned
- Sep 26, 2022
- Last updated
- Sep 26, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | LGP13052 | MD | Primary |
Addresses
Primary practice location
6930 Carroll Ave Ste 610
Takoma Park, MD 20912-4498
Mailing address
6930 Carroll Ave Ste 610
Takoma Park, MD 20912-4498
Phone (301) 563-9156
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jun 3, 2026 through Jun 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LGP13052 | MD | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1664150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1664150400000",
"number": "1215650015",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6930 CARROLL AVE STE 610",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124498",
"telephone_number": "301-563-9156"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6930 CARROLL AVE STE 610",
"city": "TAKOMA PARK",
"state": "MD",
"postal_code": "209124498",
"telephone_number": "301-563-9156"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHEPARD-EL-INCE",
"first_name": "KIMBERLEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-09-26",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MD",
"license": "LGP13052",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Takoma Park, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.