Provider Demographics
NPI:1134360829
Name:SHIVELY, JENNIFER G (LPC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:G
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9601 GAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-4963
Mailing Address - Country:US
Mailing Address - Phone:804-592-1572
Mailing Address - Fax:630-473-2753
Practice Address - Street 1:9601 GAYTON RD
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4963
Practice Address - Country:US
Practice Address - Phone:804-592-1572
Practice Address - Fax:630-473-2753
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-10
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAS282930-9101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional