Healthcare Provider Details

I. General information

NPI: 1396531091
Provider Name (Legal Business Name): SHANTA ELIZABETH WARD PANNELL MA., QMHP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/17/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 MEADOWVIEW DR STE 5-6
DANVILLE VA
24541-7351
US

IV. Provider business mailing address

5721 LEVEL RUN RD
LONG ISLAND VA
24569-2237
US

V. Phone/Fax

Practice location:
  • Phone: 877-848-9810
  • Fax:
Mailing address:
  • Phone: 434-421-9304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0709026322
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0733003038
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: