Doctor Name: | ANSLEY SHACKELFORD |
NPI Number: | 1023465077 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC, NCC |
License Number: | PRC14599 |
Business Practice Address: | 7010 Braddock Rd Annandale, VA - 220036006 |
Business Phone Number: | 7039418810 |
Business Fax Number: | |
Mailing Address: | 302 Cloverway Dr, ALEXANDRIA |
State: | VA |
Postal Code: | 223144818 |
Phone Number: | 7034027314 |
Fax Number: | |
NPI Enumeration Date: | 05/19/2016 |
NPI Last Update Date: | 05/19/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | PRC14599 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |