Individual
ALYSSA FAITH SHADBOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3910 OLD BUCKINGHAM RD, POWHATAN, VA 23139-5757
(804) 464-8803
Mailing address
3910 OLD BUCKINGHAM RD, POWHATAN, VA 23139-5757
(804) 464-8803
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904013859
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1467448571
—
VA
Enumeration date
03/29/2022
Last updated
08/03/2022
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