Provider Demographics
NPI:1417104233
Name:STORMS, SHANA (LPC, LSATP, NCC,)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:
Last Name:STORMS
Suffix:
Gender:F
Credentials:LPC, LSATP, NCC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 HEADLANDS CIR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3640
Mailing Address - Country:US
Mailing Address - Phone:703-651-6382
Mailing Address - Fax:
Practice Address - Street 1:201 N. UNION ST
Practice Address - Street 2:SUITE 110 #11077
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2231
Practice Address - Country:US
Practice Address - Phone:703-261-9331
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-22
Last Update Date:2022-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010498101YA0400X, 101Y00000X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)