Healthcare Provider Details

I. General information

NPI: 1629790795
Provider Name (Legal Business Name): JAMIE GILBERT SHAWN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 01/22/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NEW POINT RD STE 3201
WILLIAMSBURG VA
23188-9423
US

IV. Provider business mailing address

212 W QUEENS DR
WILLIAMSBURG VA
23185-4919
US

V. Phone/Fax

Practice location:
  • Phone: 757-645-3558
  • Fax: 757-645-3668
Mailing address:
  • Phone: 540-588-8851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number0701011633
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: