Provider Demographics
NPI:1700844065
Name:SHUART, THERESA AILEEN (LPC, LMFT, MED)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:AILEEN
Last Name:SHUART
Suffix:
Gender:F
Credentials:LPC, LMFT, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 SCENIC LN
Mailing Address - Street 2:
Mailing Address - City:RICH CREEK
Mailing Address - State:VA
Mailing Address - Zip Code:24147-9673
Mailing Address - Country:US
Mailing Address - Phone:703-677-7545
Mailing Address - Fax:
Practice Address - Street 1:216 SCENIC LN
Practice Address - Street 2:
Practice Address - City:RICH CREEK
Practice Address - State:VA
Practice Address - Zip Code:24147-9673
Practice Address - Country:US
Practice Address - Phone:703-677-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
24115101Y00000X, 101YA0400X
MDLC6203101YP2500X
VA0701001796101YP2500X
IA110400106H00000X
MDLCM540106H00000X
ORT2220106H00000X
VA07100387106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional