Provider Demographics
NPI:1669018537
Name:SHELLMAN, LISA EVETTE HARRELL (QMHP-A, QMHP-C)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:EVETTE HARRELL
Last Name:SHELLMAN
Suffix:
Gender:F
Credentials:QMHP-A, QMHP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 ELMWOOD CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3202
Mailing Address - Country:US
Mailing Address - Phone:757-201-2302
Mailing Address - Fax:
Practice Address - Street 1:323 ELMWOOD CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3202
Practice Address - Country:US
Practice Address - Phone:757-201-2302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0733005430101YM0800X
103T00000X, 171M00000X, 251S00000X, 261QE0700X
VA0732005792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health
No261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment