Provider Demographics
NPI:1538704077
Name:SHAMBERGER, DOMINIQUE (LCSW)
Entity Type:Individual
Prefix:
First Name:DOMINIQUE
Middle Name:
Last Name:SHAMBERGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:
Other - Last Name:COLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP-S
Mailing Address - Street 1:5303 WEEPING CHERRY DR
Mailing Address - Street 2:
Mailing Address - City:BROWNS SUMMIT
Mailing Address - State:NC
Mailing Address - Zip Code:27214-9266
Mailing Address - Country:US
Mailing Address - Phone:434-548-3910
Mailing Address - Fax:
Practice Address - Street 1:709 RIVER RIDGE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-8303
Practice Address - Country:US
Practice Address - Phone:434-548-3910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2023-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09060082251041C0700X
09040151051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical