Healthcare Provider Details

I. General information

NPI: 1619897998
Provider Name (Legal Business Name): SHELLY LEA COGBILL LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 BIRCH POINT CT
RICHMOND VA
23228-2657
US

IV. Provider business mailing address

4112 BIRCH POINT CT
RICHMOND VA
23228-2657
US

V. Phone/Fax

Practice location:
  • Phone: 804-441-2457
  • Fax:
Mailing address:
  • Phone: 804-441-2457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0717001582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: