Healthcare Provider Details

I. General information

NPI: 1114414919
Provider Name (Legal Business Name): SHELLEY TOWNER MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2018
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 W MAIN ST
CHARLOTTESVILLE VA
22903-2824
US

IV. Provider business mailing address

1215 LEE STREET PO BOX 800386
CHARLOTTESVILLE VA
22908-0386
US

V. Phone/Fax

Practice location:
  • Phone: 434-982-4146
  • Fax: 434-924-1797
Mailing address:
  • Phone: 434-982-4146
  • Fax: 434-924-1797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number0139000009
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: