Provider Demographics
NPI:1710032719
Name:PROSSER, SHIRLEY J (MA EDS LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:J
Last Name:PROSSER
Suffix:
Gender:F
Credentials:MA EDS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SOUTH KENT STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601
Mailing Address - Country:US
Mailing Address - Phone:540-667-8004
Mailing Address - Fax:540-667-3567
Practice Address - Street 1:21 SOUTH KENT STREET
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601
Practice Address - Country:US
Practice Address - Phone:540-667-8004
Practice Address - Fax:540-667-3567
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002151101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional