Provider Demographics
NPI:1629446455
Name:EPPS, SHALETA
Entity Type:Individual
Prefix:
First Name:SHALETA
Middle Name:
Last Name:EPPS
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 1:12501 BRANNER WAY APT 103
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-2806
Mailing Address - Country:US
Mailing Address - Phone:804-721-9715
Mailing Address - Fax:
Practice Address - Street 1:1500 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-2308
Practice Address - Country:US
Practice Address - Phone:804-225-9144
Practice Address - Fax:804-225-9145
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-10
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040088771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical