Provider Demographics
NPI:1891915443
Name:SHEA, VIRGINIA DECUIR (LCSW LMFT)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:DECUIR
Last Name:SHEA
Suffix:
Gender:F
Credentials:LCSW LMFT
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 9685
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70562-9685
Mailing Address - Country:US
Mailing Address - Phone:337-365-7575
Mailing Address - Fax:337-365-7878
Practice Address - Street 1:203 WEST MAIN STREET
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560
Practice Address - Country:US
Practice Address - Phone:337-365-7575
Practice Address - Fax:337-365-7878
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40501041C0700X
LA967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4H723CS68Medicare ID - Type Unspecified