Provider Demographics
NPI:1306467147
Name:SHENANDOAH CREATIVE COUNSELING FOR CHILDREN AND ADOLESCENTS
Entity type:Organization
Organization Name:SHENANDOAH CREATIVE COUNSELING FOR CHILDREN AND ADOLESCENTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:STONE
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:540-471-9022
Mailing Address - Street 1:510 W BROAD ST STE H
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-4548
Mailing Address - Country:US
Mailing Address - Phone:540-471-9022
Mailing Address - Fax:540-941-8807
Practice Address - Street 1:510 W BROAD ST STE H
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-4548
Practice Address - Country:US
Practice Address - Phone:540-471-9022
Practice Address - Fax:540-941-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health