Individual
SHASTA LASHAY DOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW
Contact information
Practice address
10300 EATON PL STE 440, FAIRFAX, VA 22030-2239
(256) 717-4095
Mailing address
10904 HARPERS SQUARE CT, RESTON, VA 20191-5011
(256) 717-4095
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
VA
Other
Enumeration date
10/21/2025
Last updated
10/21/2025
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