Individual
SHANNON E CUSACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
3010 SUMMERHURST DR, MIDLOTHIAN, VA 23113-2181
(804) 319-0741
Mailing address
3010 SUMMERHURST DR, MIDLOTHIAN, VA 23113-2181
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810008186
VA
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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