Provider Demographics
NPI:1780395178
Name:POULTER, SHELTON PILAND (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELTON
Middle Name:PILAND
Last Name:POULTER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 N WASHINGTON ST STE 322
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-6498
Mailing Address - Country:US
Mailing Address - Phone:540-845-6940
Mailing Address - Fax:
Practice Address - Street 1:2201 CHARLES ST STE 105
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3378
Practice Address - Country:US
Practice Address - Phone:540-845-6940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0904146361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical