Provider Demographics
NPI:1801696521
Name:SHORT, YASHICA L
Entity type:Individual
Prefix:
First Name:YASHICA
Middle Name:L
Last Name:SHORT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2060 ATWATER CIR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23509-2121
Mailing Address - Country:US
Mailing Address - Phone:757-362-2878
Mailing Address - Fax:
Practice Address - Street 1:2117 SMITH AVE STE E
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2519
Practice Address - Country:US
Practice Address - Phone:757-362-2878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-13
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704016534101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health