Individual
LON SHACKELFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 296-9161
(434) 296-1150
Mailing address
1011 E JEFFERSON ST, CHARLOTTESVILLE, VA 22902-5354
(434) 971-9611
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
0810000773
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007711387
—
VA
01
—
083119
VERI/OPTIMA
VA
01
—
333845
ANTHEM
VA
Enumeration date
08/14/2006
Last updated
12/08/2010
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