Provider Demographics
NPI:1609357763
Name:DENARD CLAY, SHANTA
Entity Type:Individual
Prefix:
First Name:SHANTA
Middle Name:
Last Name:DENARD CLAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHANTA
Other - Middle Name:
Other - Last Name:DENARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12049 ALMER LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-3081
Mailing Address - Country:US
Mailing Address - Phone:224-425-9388
Mailing Address - Fax:
Practice Address - Street 1:12049 ALMER LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-3081
Practice Address - Country:US
Practice Address - Phone:224-425-9388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040157221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical