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General NPI Number Information
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NPI Number | 1144393422
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Entity Type | Individual
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Provider Name | CHARLES J SHELTON LPC PHD
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Gender | Male
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 224 GREAT BRIDGE BLVD CHESAPEAKE COMM SERV BOARD
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-547-9334
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Fax | 757-819-6292
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Provider Business Mailing Address
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Address Line | PO BOX 1647 224 GREAT BRIDGE BLVD CHESAPEAKE COMMUNITY SERVICES BOA
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City | CHESAPEAKE
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State | VA
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Zip | 23320
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Country | US
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Telephone | 757-547-9334
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Fax | 757-819-6292
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 0701000523
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 0717000221
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License Number State | VA
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