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General NPI Number Information
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NPI Number | 1487892014
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Entity Type | Individual
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Provider Name | VIVIAN ALLISON SHELTON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 02/04/2009
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Last Update Date | 05/16/2019
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Provider Practice Location Address
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Address Line | 6723 WHITTIER AVE SUITE 207
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City | MC LEAN
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State | VA
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Zip | 22101-4522
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Country | US
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Telephone | 703-475-6478
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Fax |
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Provider Business Mailing Address
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Address Line | 6723 WHITTIER AVE SUITE 207
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City | MC LEAN
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State | VA
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Zip | 22101-4522
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Country | US
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Telephone | 703-475-6478
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 8990
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810003370
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License Number State | VA
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