Provider Demographics
NPI:1053674960
Name:SHIELDS, VICTORIA LYNN (MDIV, MED, LCAS)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:LYNN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:MDIV, MED, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1709 LEGION RD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-2375
Mailing Address - Country:US
Mailing Address - Phone:919-903-6167
Mailing Address - Fax:
Practice Address - Street 1:1709 LEGION RD
Practice Address - Street 2:SUITE 112
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-2375
Practice Address - Country:US
Practice Address - Phone:919-903-6167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral