Provider Demographics
NPI:1033250139
Name:ZODY, THERESA SHIELDS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:SHIELDS
Last Name:ZODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6002 W BROAD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-2213
Mailing Address - Country:US
Mailing Address - Phone:804-257-5488
Mailing Address - Fax:
Practice Address - Street 1:6002 W BROAD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2213
Practice Address - Country:US
Practice Address - Phone:804-257-5488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904002711101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231190OtherBCBS ID