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

Table of content: (NPI 1477689628)

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".