1881115590 NPI number — SHAWN PATRICK MCNULTY LPC, NCC, M.ED.

Table of content: SHAWN PATRICK MCNULTY LPC, NCC, M.ED. (NPI 1881115590)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881115590 NPI number — SHAWN PATRICK MCNULTY LPC, NCC, M.ED.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNULTY
Provider First Name:
SHAWN
Provider Middle Name:
PATRICK
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, NCC, M.ED.
Provider Gender Code:
M

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:
1881115590
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1769 JAMESTOWN RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WILLIAMSBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23185-2310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-952-6767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
COLONIAL BEHAVIORAL HEALTH
Provider Second Line Business Practice Location Address:
1657 MERRIMAC TRAIL
Provider Business Practice Location Address City Name:
WILLIAMSBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-220-3200
Provider Business Practice Location Address Fax Number:
757-903-4992
Provider Enumeration Date:
07/03/2017

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  0701007505 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0701007505 . This is a "LICENSED PROFESSIONAL COUNSELOR" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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