Provider Demographics
NPI:1013767557
Name:SHULL, JAMIE LEE (LPC)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:SHULL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22405-2049
Mailing Address - Country:US
Mailing Address - Phone:202-510-0390
Mailing Address - Fax:
Practice Address - Street 1:2052 RICHMOND HWY STE 201
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7286
Practice Address - Country:US
Practice Address - Phone:540-699-0226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-26
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701012910101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional