Provider Demographics
NPI:1194804575
Name:CONKLIN, SHIRLEY O (LPC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:O
Last Name:CONKLIN
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 1:224 GREAT BRIDGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-3904
Mailing Address - Country:US
Mailing Address - Phone:757-547-9334
Mailing Address - Fax:757-819-6292
Practice Address - Street 1:224 GREAT BRIDGE BLVD
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-3904
Practice Address - Country:US
Practice Address - Phone:757-547-9334
Practice Address - Fax:757-819-6292
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003283101Y00000X
VA0701003283LPC101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA143676OtherANTHEM TRIGON
VA484893000OtherMAGELLAN HEALTH
VA089111OtherOPTIMA/SENTARA
VA518306OtherVALUE OPTIONS
VA343506OtherFED HEALTH NET TRICARE