Individual
MR. KENNETH MARVIN SHIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
11114 LANTERN WAY, NORTH CHESTERFIELD, VA 23236-3575
(804) 814-2452
Mailing address
11114 LANTERN WAY, NORTH CHESTERFIELD, VA 23236-3575
(804) 814-2452
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
070100652
VA
Other
Enumeration date
02/15/2019
Last updated
02/15/2019
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