MEDICARE: SHAVON L BAILEY 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	0701005389	VA

General Provider Information

NPI Number	:	1699012443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAVON L BAILEY LPC

Provider Business Mailing Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5213 HICKORY PARK DR STE A
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-2617
Country	:	US
Telephone Number	:	804-207-6737
Fax Number	:

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

Provider Enumeration Date	:	01/14/2013
Last Update Date	:	10/13/2025

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