Provider Demographics
NPI:1588867923
Name:FONTANELLA, SHELLEY E (LPC)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:E
Last Name:FONTANELLA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 S GLEBE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1655
Mailing Address - Country:US
Mailing Address - Phone:703-521-6004
Mailing Address - Fax:
Practice Address - Street 1:46 S GLEBE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1655
Practice Address - Country:US
Practice Address - Phone:703-521-6004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
VA0701004661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health