Provider Demographics
NPI:1588174189
Name:MIEHE, SHAWNA RAE (BCABA, LABA)
Entity type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:RAE
Last Name:MIEHE
Suffix:
Gender:F
Credentials:BCABA, LABA
Other - Prefix:MS
Other - First Name:SHAWNA
Other - Middle Name:RAE
Other - Last Name:MORIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9625 CAPEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23503-2601
Mailing Address - Country:US
Mailing Address - Phone:720-409-2112
Mailing Address - Fax:
Practice Address - Street 1:638 INDEPENDENCE PKWY
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-5216
Practice Address - Country:US
Practice Address - Phone:757-276-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0134000182103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst