Healthcare Provider Details

I. General information

NPI: 1457736159
Provider Name (Legal Business Name): SHELBY DAWN KASEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 11/11/2025
Certification Date: 11/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 VALLEY VIEW BLVD NW
ROANOKE VA
24012-2000
US

IV. Provider business mailing address

PO BOX 1115
VINTON VA
24179-8115
US

V. Phone/Fax

Practice location:
  • Phone: 540-202-1262
  • Fax: 826-926-6985
Mailing address:
  • Phone: 540-202-1262
  • Fax: 826-926-6985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904009079
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: