Provider Demographics
NPI:1609579085
Name:JOBE-SHIELDS, LISA EMILY
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:EMILY
Last Name:JOBE-SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 TURNMILL DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5565
Mailing Address - Country:US
Mailing Address - Phone:703-231-6157
Mailing Address - Fax:
Practice Address - Street 1:1324 TURNMILL DR
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5565
Practice Address - Country:US
Practice Address - Phone:703-231-6157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-23
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical