Provider Demographics
NPI:1215554290
Name:HARRISON, SHA'VONNE LANIECE (LPC)
Entity Type:Individual
Prefix:MS
First Name:SHA'VONNE
Middle Name:LANIECE
Last Name:HARRISON
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 1:10144 VIRGINIA RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-2347
Mailing Address - Country:US
Mailing Address - Phone:804-477-9939
Mailing Address - Fax:
Practice Address - Street 1:10144 VIRGINIA RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-2347
Practice Address - Country:US
Practice Address - Phone:804-477-9939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008890101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional