Healthcare Provider Details

I. General information

NPI: 1457028144
Provider Name (Legal Business Name): VICKIE L SHUFF LGSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2021
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 INDUSTRIAL PARK RD
MAXWELTON WV
24957-8066
US

IV. Provider business mailing address

PO BOX 253
CRAWLEY WV
24931-0253
US

V. Phone/Fax

Practice location:
  • Phone: 304-497-0500
  • Fax:
Mailing address:
  • Phone: 304-520-5061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberBP00945901
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: