Provider Demographics
NPI:1568617652
Name:SHUFFLETON, MARY (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:SHUFFLETON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13103 BECKMAN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-0247
Mailing Address - Country:US
Mailing Address - Phone:540-898-5961
Mailing Address - Fax:
Practice Address - Street 1:8320 PROFESSIONAL HILL DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4611
Practice Address - Country:US
Practice Address - Phone:703-876-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004336101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional