Provider Demographics
NPI:1821606534
Name:SHENANDOAH FAMILY THERAPY LLC
Entity Type:Organization
Organization Name:SHENANDOAH FAMILY THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WALKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-324-9079
Mailing Address - Street 1:348 LOUISA ST
Mailing Address - Street 2:
Mailing Address - City:BROADWAY
Mailing Address - State:VA
Mailing Address - Zip Code:22815-9408
Mailing Address - Country:US
Mailing Address - Phone:540-324-9079
Mailing Address - Fax:
Practice Address - Street 1:348 LOUISA ST
Practice Address - Street 2:
Practice Address - City:BROADWAY
Practice Address - State:VA
Practice Address - Zip Code:22815-9408
Practice Address - Country:US
Practice Address - Phone:540-324-9079
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-20
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health