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:
Health care specialties
Specialty | Code | License # | 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 14 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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1366455305 | NPPES |
Virginia | Other | 083119 | VERI/OPTIMA |
Virginia | MEDICAID | 007711387 | VERI/OPTIMA |
Virginia | Other | 333845 | VERI/OPTIMA |
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