Provider Demographics
NPI:1336214667
Name:DODD, SHELBY GLASS (LPC LIC PROF COUNS)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:GLASS
Last Name:DODD
Suffix:
Gender:F
Credentials:LPC LIC PROF COUNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7501 RIVER RD
Mailing Address - Street 2:1B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23607
Mailing Address - Country:US
Mailing Address - Phone:757-928-3158
Mailing Address - Fax:727-928-3158
Practice Address - Street 1:2208 EXECUTIVE DR
Practice Address - Street 2:SUITES A & E
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23607
Practice Address - Country:US
Practice Address - Phone:757-928-3158
Practice Address - Fax:727-928-3158
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701001527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA098104OtherANTHEM BLUE CROSS
VA5401429Medicaid
VA085147OtherSENTORA