Provider Demographics
NPI:1457700379
Name:CUTSHALL, SHANNON (PHD, LCP)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:CUTSHALL
Suffix:
Gender:F
Credentials:PHD, LCP
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:CUTSHALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:420 N CENTER DR STE 239B
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-0014
Mailing Address - Country:US
Mailing Address - Phone:757-282-6309
Mailing Address - Fax:757-282-6309
Practice Address - Street 1:420 N CENTER DR STE 239B
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-0014
Practice Address - Country:US
Practice Address - Phone:757-282-6309
Practice Address - Fax:757-282-6309
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701006669101YP2500X
VA0810007357103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0810007357OtherPHD LICENSE