Provider Demographics
NPI:1023164126
Name:SHUMATE, ELIZABETH BOAN (LCSW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BOAN
Last Name:SHUMATE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3204 KENMORE DR
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23661-3420
Mailing Address - Country:US
Mailing Address - Phone:540-267-6264
Mailing Address - Fax:
Practice Address - Street 1:3204 KENMORE DR
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23661-3420
Practice Address - Country:US
Practice Address - Phone:540-267-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040034911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA000068192OtherUNITED BEHAVIORAL HEALTH
VA351786OtherANTHEM BC/BS
VA302441OtherANTHEM BC / BS
VA83936MOtherSENTARA MENTAL HEALTH MANAGEMENT
VA166603OtherCOMPSYCH
VA1023164126Medicaid
VA1023164126OtherFIRST HEALTH
VA276944000OtherMAGELLAN
VA57594OtherHORIZON
VA7499285OtherAETNA
VA7499285OtherAETNA
VA574424Medicare UPIN