Provider Demographics
NPI:1447425152
Name:SHAHEEN, KIMBERLY HEATHER (LCSW, MED)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:HEATHER
Last Name:SHAHEEN
Suffix:
Gender:F
Credentials:LCSW, MED
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 35395
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-0395
Mailing Address - Country:US
Mailing Address - Phone:804-909-1334
Mailing Address - Fax:804-355-0225
Practice Address - Street 1:4914 RADFORD AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3538
Practice Address - Country:US
Practice Address - Phone:804-909-1334
Practice Address - Fax:804-355-0225
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040067631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical