Provider Demographics
NPI:1932539681
Name:SHACKELFORD, NORDIA (LICSW)
Entity Type:Individual
Prefix:
First Name:NORDIA
Middle Name:
Last Name:SHACKELFORD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3272 CALIFORNIA AVE SW STE 300
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-3375
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3272 CALIFORNIA AVE SW STE 300
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-3375
Practice Address - Country:US
Practice Address - Phone:206-289-0438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-16
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040089721041C0700X
NY0778401041C0700X
WALW607652771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical