Provider Demographics
NPI:1154398436
Name:SHENANDOAH PROFESSIONAL COUNSELING, LLC
Entity type:Organization
Organization Name:SHENANDOAH PROFESSIONAL COUNSELING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PRACTIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:SMOOT
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-662-3455
Mailing Address - Street 1:133 W BOSCAWEN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4190
Mailing Address - Country:US
Mailing Address - Phone:540-662-3455
Mailing Address - Fax:540-662-3455
Practice Address - Street 1:133 W BOSCAWEN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-4190
Practice Address - Country:US
Practice Address - Phone:540-662-3455
Practice Address - Fax:540-662-3455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-04
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701003862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010223393Medicaid
VAO86004MOtherSENTARA/FAMIS/EAP
VA086004MOtherOPTIMA/COMMUNITY HEALTH
VA010234549Medicaid
VA184671OtherANTHEM