Healthcare Provider Details

I. General information

NPI: 1205006475
Provider Name (Legal Business Name): SHELIA MARIE MORAN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

291 PARK AVE
DANVILLE VA
24541-4233
US

IV. Provider business mailing address

291 PARK AVE
DANVILLE VA
24541-4233
US

V. Phone/Fax

Practice location:
  • Phone: 434-799-3310
  • Fax: 434-799-3317
Mailing address:
  • Phone: 434-799-3310
  • Fax: 434-799-3317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904004396
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: