Provider Demographics
NPI:1881115590
Name:MCNULTY, SHAWN PATRICK (LPC, NCC, MED)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:PATRICK
Last Name:MCNULTY
Suffix:
Gender:M
Credentials:LPC, NCC, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1769 JAMESTOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23185-2310
Mailing Address - Country:US
Mailing Address - Phone:757-952-6767
Mailing Address - Fax:
Practice Address - Street 1:COLONIAL BEHAVIORAL HEALTH
Practice Address - Street 2:1657 MERRIMAC TRAIL
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-220-3200
Practice Address - Fax:757-903-4992
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-03
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701007505101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701007505OtherLICENSED PROFESSIONAL COUNSELOR