MEDICARE: MRS. SARAH C SHAKER LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	0701007120	VA

General Provider Information

NPI Number	:	1053813816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH C SHAKER LPC

Provider Business Mailing Address
First Line	:	104 TRILBY CT
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23325-2237
Country	:	US
Telephone Number	:	757-785-5682
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 INVESTORS PL STE 204I
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1167
Country	:	US
Telephone Number	:	757-785-5682
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	08/19/2019

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