Shackelford, Lon

Shackelford, Lon is an individual health care provider with primary practice located at 1011 E Jefferson St , Charlottesville VA 22902-5354. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Shackelford, Lon can be contacted via phone (434) 296-9161.

Contact Information

Primary practice address
1011 E Jefferson St Charlottesville VA 22902-5354
Phone: (434) 296-9161
Fax: (434) 296-1150
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X 0810000773 Virginia

Profile Details

NPI number 1366455305
LBN Legal business name Shackelford, Lon
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 14th, 2006
Last updated Dec 8th, 2010 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1366455305 NPPES
Virginia Other 083119 VERI/OPTIMA
Virginia MEDICAID 007711387 VERI/OPTIMA
Virginia Other 333845 VERI/OPTIMA

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