Provider Demographics
NPI:1649859208
Name:SHOOK, KRISTA NICOLE (MSED)
Entity type:Individual
Prefix:MISS
First Name:KRISTA
Middle Name:NICOLE
Last Name:SHOOK
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4260 MEADOW WOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-4231
Mailing Address - Country:US
Mailing Address - Phone:757-613-0483
Mailing Address - Fax:
Practice Address - Street 1:2021 CUNNINGHAM DR STE 400
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-3371
Practice Address - Country:US
Practice Address - Phone:757-838-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704013787101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health