Provider Demographics
NPI:1174349989
Name:SHANER, KRYSTAL (LPC)
Entity type:Individual
Prefix:
First Name:KRYSTAL
Middle Name:
Last Name:SHANER
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 1:835 GLENROCK RD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3767
Mailing Address - Country:US
Mailing Address - Phone:757-805-4399
Mailing Address - Fax:
Practice Address - Street 1:835 GLENROCK RD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3767
Practice Address - Country:US
Practice Address - Phone:757-805-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701014205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional