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General NPI Number Information
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NPI Number | 1124216577
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Entity Type | Individual
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Provider Name | EMMA L SHORT LPC, CSOTP
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Gender | Female
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 10/11/2007
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Provider Practice Location Address
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Address Line | 514 E ATLANTIC ST
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City | SOUTH HILL
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State | VA
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Zip | 23970-2704
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Country | US
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Telephone | 434-949-6360
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 211
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City | ALBERTA
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State | VA
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Zip | 23821-0211
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Country | US
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Telephone | 434-949-6360
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 0812000550
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 0701003580
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License Number State | VA
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