Provider Demographics
NPI:1699012443
Name:BAILEY, SHAVON L (LPC)
Entity type:Individual
Prefix:
First Name:SHAVON
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6049 RIVERMERE LN
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-8075
Mailing Address - Country:US
Mailing Address - Phone:804-839-6482
Mailing Address - Fax:
Practice Address - Street 1:6049 RIVERMERE LN
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-8075
Practice Address - Country:US
Practice Address - Phone:804-839-6482
Practice Address - Fax:804-819-5221
Is Sole Proprietor?:No
Enumeration Date:2013-01-14
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005389101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional