Provider Demographics
NPI:1750045381
Name:EDMOND, DONNESHIA SHANTA (LPC)
Entity Type:Individual
Prefix:
First Name:DONNESHIA
Middle Name:SHANTA
Last Name:EDMOND
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 1:2629 BALLENTINE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-2303
Mailing Address - Country:US
Mailing Address - Phone:757-289-7749
Mailing Address - Fax:
Practice Address - Street 1:2629 BALLENTINE BLVD
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23509-2303
Practice Address - Country:US
Practice Address - Phone:202-812-3187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701010861101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional