Provider Demographics
NPI:1629186754
Name:VANDIVER, SHIRLEY JOYCE (MED LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:JOYCE
Last Name:VANDIVER
Suffix:
Gender:F
Credentials:MED LPC
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:JOYCE
Other - Last Name:CURTIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED LPC
Mailing Address - Street 1:300 FORT ZUMWALT SQUARE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OFALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-3078
Mailing Address - Country:US
Mailing Address - Phone:636-240-3931
Mailing Address - Fax:636-639-9312
Practice Address - Street 1:300 FORT ZUMWALT SQUARE
Practice Address - Street 2:SUITE 121
Practice Address - City:OFALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-3078
Practice Address - Country:US
Practice Address - Phone:636-240-3931
Practice Address - Fax:636-639-9312
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001418101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional