Provider Demographics
NPI:1124216577
Name:SHORT, EMMA L (LPC, CSOTP)
Entity Type:Individual
Prefix:MS
First Name:EMMA
Middle Name:L
Last Name:SHORT
Suffix:
Gender:F
Credentials:LPC, CSOTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 211
Mailing Address - Street 2:
Mailing Address - City:ALBERTA
Mailing Address - State:VA
Mailing Address - Zip Code:23821-0211
Mailing Address - Country:US
Mailing Address - Phone:434-949-6360
Mailing Address - Fax:
Practice Address - Street 1:514 E ATLANTIC ST
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-2704
Practice Address - Country:US
Practice Address - Phone:434-949-6360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0812000550101Y00000X
VA0701003580101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor