Healthcare Provider Details

I. General information

NPI: 1609948181
Provider Name (Legal Business Name): SHELLEY VASQUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 11/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W WILLIAMSBURG RD
SANDSTON VA
23150-2009
US

IV. Provider business mailing address

1 W WILLIAMSBURG RD
SANDSTON VA
23150-2009
US

V. Phone/Fax

Practice location:
  • Phone: 804-908-2532
  • Fax: 804-343-1613
Mailing address:
  • Phone: 804-864-1320
  • Fax: 804-864-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number701001818
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: