Healthcare Provider Details

I. General information

NPI: 1699806042
Provider Name (Legal Business Name): DOROTHY G. SHANLEY LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1025 MAIN ST STE 310
WHEELING WV
26003-2741
US

IV. Provider business mailing address

1025 MAIN ST STE 310
WHEELING WV
26003-2741
US

V. Phone/Fax

Practice location:
  • Phone: 304-233-2020
  • Fax: 304-232-7245
Mailing address:
  • Phone: 304-233-2020
  • Fax: 304-232-7245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1828
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: