Provider Demographics
NPI:1568519163
Name:SHEA, ELAINE DARLENE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELAINE
Middle Name:DARLENE
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 HORNER ST
Mailing Address - Street 2:210
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-3433
Mailing Address - Country:US
Mailing Address - Phone:540-349-9877
Mailing Address - Fax:540-349-9877
Practice Address - Street 1:35 HORNER ST
Practice Address - Street 2:210
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3433
Practice Address - Country:US
Practice Address - Phone:540-349-9877
Practice Address - Fax:540-349-9877
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904001787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA085878Medicare UPIN