Provider Demographics
NPI:1083471858
Name:FAULKNER, SHELLEY (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 TAYLORS GAP RD
Mailing Address - Street 2:
Mailing Address - City:NORTH GARDEN
Mailing Address - State:VA
Mailing Address - Zip Code:22959-1700
Mailing Address - Country:US
Mailing Address - Phone:317-460-9958
Mailing Address - Fax:
Practice Address - Street 1:300 CLAREMONT LN STE 103
Practice Address - Street 2:
Practice Address - City:CROZET
Practice Address - State:VA
Practice Address - Zip Code:22932-3455
Practice Address - Country:US
Practice Address - Phone:434-466-1588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-28
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA701012879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional