Provider Demographics
NPI:1093466872
Name:TEASLEY, SHELBY COSHETTA (QMHP-A,C)
Entity Type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:COSHETTA
Last Name:TEASLEY
Suffix:
Gender:F
Credentials:QMHP-A,C
Other - Prefix:MR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:BREEDLOVE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:QMHP,A,C
Mailing Address - Street 1:7300 HANOVER GREEN DR STE 300-A
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-1705
Mailing Address - Country:US
Mailing Address - Phone:804-497-9064
Mailing Address - Fax:
Practice Address - Street 1:7300 HANOVER GREEN DR STE 300-A
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23111-1705
Practice Address - Country:US
Practice Address - Phone:804-497-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-13
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional