Healthcare Provider Details

I. General information

NPI: 1649925017
Provider Name (Legal Business Name): SHAINA C THEIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2022
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 KY 59
VANCEBURG KY
41179-7647
US

IV. Provider business mailing address

PO BOX 550
VANCEBURG KY
41179-0550
US

V. Phone/Fax

Practice location:
  • Phone: 606-796-3029
  • Fax:
Mailing address:
  • Phone: 606-796-3029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number256482
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: