Provider Demographics
NPI:1821547639
Name:MAYS-COUCH, SHELLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:MAYS-COUCH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0037
Mailing Address - Country:US
Mailing Address - Phone:434-547-2545
Mailing Address - Fax:855-843-9298
Practice Address - Street 1:1839 THOMAS JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:CHARLOTTE COURT HOUSE
Practice Address - State:VA
Practice Address - Zip Code:23923-3818
Practice Address - Country:US
Practice Address - Phone:434-547-2545
Practice Address - Fax:855-843-9298
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904009536101YM0800X, 101YP1600X, 101YP2500X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional