Healthcare Provider Details

I. General information

NPI: 1487489134
Provider Name (Legal Business Name): SHUMATE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 OLD FOREST RD STE A
LYNCHBURG VA
24501-2335
US

IV. Provider business mailing address

2900 OLD FOREST RD STE A
LYNCHBURG VA
24501-2335
US

V. Phone/Fax

Practice location:
  • Phone: 206-235-0968
  • Fax:
Mailing address:
  • Phone: 434-316-1826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: HOLLY SHUMATE
Title or Position: OWNER
Credential:
Phone: 206-235-0968