Provider Demographics
NPI:1689995524
Name:TREWARTHA, SHANNON LEIGH (ATR-BC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:LEIGH
Last Name:TREWARTHA
Suffix:
Gender:F
Credentials:ATR-BC, LPC
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:281 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 326
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-2986
Mailing Address - Country:US
Mailing Address - Phone:757-490-0377
Mailing Address - Fax:757-497-1327
Practice Address - Street 1:142 W YORK ST
Practice Address - Street 2:SUITE 817
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-2015
Practice Address - Country:US
Practice Address - Phone:757-622-2114
Practice Address - Fax:757-497-1327
Is Sole Proprietor?:No
Enumeration Date:2010-06-15
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0701004842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional