Provider Demographics
NPI:1609948181
Name:VASQUEZ, SHELLEY (LPC)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:VASQUEZ
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 1:1 W WILLIAMSBURG RD
Mailing Address - Street 2:
Mailing Address - City:SANDSTON
Mailing Address - State:VA
Mailing Address - Zip Code:23150-2009
Mailing Address - Country:US
Mailing Address - Phone:804-864-1320
Mailing Address - Fax:804-864-1323
Practice Address - Street 1:1 W WILLIAMSBURG RD
Practice Address - Street 2:
Practice Address - City:SANDSTON
Practice Address - State:VA
Practice Address - Zip Code:23150-2009
Practice Address - Country:US
Practice Address - Phone:804-908-2532
Practice Address - Fax:804-343-1613
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA701001818101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional