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General NPI Number Information
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NPI Number | 1245751429
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Entity Type | Individual
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Provider Name | SHONDA LATRESE TOWNSEND
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 06/28/2017
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Provider Practice Location Address
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Address Line | 5283 WINDSOR BLVD
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City | ZUNI
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State | VA
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Zip | 23898
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Country | US
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Telephone | 757-242-5059
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Fax |
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Provider Business Mailing Address
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Address Line | 20623 THOMAS WOODS TRL
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City | ZUNI
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State | VA
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Zip | 23898-2303
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Country | US
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Telephone | 757-676-5451
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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 | 103TM1800X
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Taxonomy Name | Intellectual & Developmental Disabilities Psychologist
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License Number | 2689
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License Number State | VA
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