Provider Demographics
NPI:1821430695
Name:FALLON, SHIELA GLYNN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHIELA
Middle Name:GLYNN
Last Name:FALLON
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 1:39 MICHELE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23669-1940
Mailing Address - Country:US
Mailing Address - Phone:757-850-9147
Mailing Address - Fax:
Practice Address - Street 1:751 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE K
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3563
Practice Address - Country:US
Practice Address - Phone:757-706-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701002992101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional