Provider Demographics
NPI:1942833520
Name:TURNER, SHANTELL
Entity Type:Individual
Prefix:
First Name:SHANTELL
Middle Name:
Last Name:TURNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14497 POTOMAC MILLS RD # 1190
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-6807
Mailing Address - Country:US
Mailing Address - Phone:757-726-7180
Mailing Address - Fax:
Practice Address - Street 1:12934 HARBOR DR # 106
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-2930
Practice Address - Country:US
Practice Address - Phone:571-572-9179
Practice Address - Fax:571-520-0614
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701011581101Y00000X, 101YP2500X
VA0718000545101YA0400X
VA0704012482101YM0800X
VA0710102917101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty