Provider Demographics
NPI:1902821879
Name:THELL, SHANA B (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:B
Last Name:THELL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:BETH
Other - Last Name:RICKETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6851 COURTHOUSE RD
Mailing Address - Street 2:FOOTSTEPS COUNSELING CENTER, SUITE 300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-5308
Mailing Address - Country:US
Mailing Address - Phone:804-715-3215
Mailing Address - Fax:804-715-3233
Practice Address - Street 1:6851 COURTHOUSE RD
Practice Address - Street 2:FOOTSTEPS COUNSELING CENTER, SUITE 300
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23832-5308
Practice Address - Country:US
Practice Address - Phone:804-715-3215
Practice Address - Fax:804-715-3233
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN162131041C0700X
VA09040053421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN430684800Medicaid
MN430684800Medicaid