Provider Demographics
NPI:1841727864
Name:SHOVELIN, EMILY GRACE (LPC, NCC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:GRACE
Last Name:SHOVELIN
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:MS
Other - First Name:EMILY
Other - Middle Name:GRACE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:465 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5232
Mailing Address - Country:US
Mailing Address - Phone:860-759-3396
Mailing Address - Fax:
Practice Address - Street 1:85 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-1803
Practice Address - Country:US
Practice Address - Phone:860-759-3396
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46003186101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health