Healthcare Provider Details

I. General information

NPI: 1417100702
Provider Name (Legal Business Name): ALEXIS ANNE SHIFLET LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXIS ANNE SLACK LCSW

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1241 N MAIN ST
HARRISONBURG VA
22802
US

IV. Provider business mailing address

1241 N MAIN ST
HARRISONBURG VA
22802-4632
US

V. Phone/Fax

Practice location:
  • Phone: 540-434-1941
  • Fax: 540-434-1791
Mailing address:
  • Phone: 540-434-1941
  • Fax: 540-434-1791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904006970
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: