Healthcare Provider Details

I. General information

NPI: 1205890860
Provider Name (Legal Business Name): SHAHANA N GARNER L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHAHANA KEISLER L.C.S.W.

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

IV. Provider business mailing address

9228 GEORGE WASHINGTON MEMORIAL HWY
GLOUCESTER VA
23061-4162
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-5068
  • Fax: 804-693-7407
Mailing address:
  • Phone: 804-693-5068
  • Fax: 804-693-7407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005579
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: