Healthcare Provider Details

I. General information

NPI: 1699498162
Provider Name (Legal Business Name): SHABRIAL HENDERSON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11357 NUCKOLS RD # 1115
GLEN ALLEN VA
23059-5504
US

IV. Provider business mailing address

11357 NUCKOLS RD # 1115
GLEN ALLEN VA
23059-5504
US

V. Phone/Fax

Practice location:
  • Phone: 804-424-0230
  • Fax: 804-203-1665
Mailing address:
  • Phone: 804-424-0230
  • Fax: 804-203-1665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904014355
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: