Provider Demographics
NPI:1699806042
Name:SHANLEY, DOROTHY G (LPC)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:G
Last Name:SHANLEY
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 1:1025 MAIN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-2741
Mailing Address - Country:US
Mailing Address - Phone:304-233-2020
Mailing Address - Fax:304-232-7245
Practice Address - Street 1:1025 MAIN ST STE 310
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-2741
Practice Address - Country:US
Practice Address - Phone:304-233-2020
Practice Address - Fax:304-232-7245
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1828101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHQ045390OtherHEALTH PLAN OF THE UPPER OHIO VALLEY