1477689628 NPI number — SHENANDOAH COUNSELING ASSOCIATES, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477689628 NPI number — SHENANDOAH COUNSELING ASSOCIATES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHENANDOAH COUNSELING ASSOCIATES, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477689628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1048 W BEVERLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STAUNTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24401-3110
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-886-5200
Provider Business Mailing Address Fax Number:
540-886-2864

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1048 W BEVERLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STAUNTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24401-3110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-886-5200
Provider Business Practice Location Address Fax Number:
540-886-2864
Provider Enumeration Date:
02/24/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
MACDONALD
Authorized Official Title or Position:
DIRECTOR-PRESIDENT
Authorized Official Telephone Number:
540-886-5200

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701000332 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2022072 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 076504 . This is a "ANTHEM BC & BS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 085322 . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".