Individual
MR. BRUCE B SHELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW, CSAC
Contact information
Practice address
921 FIRST COLONIAL RD, SUITE 1711, VIRGINIA BEACH, VA 23454-3167
(757) 428-7500
(757) 428-7699
Mailing address
921 FIRST COLONIAL RD, SUITE 1711, VIRGINIA BEACH, VA 23454-3167
(757) 428-7500
(757) 428-7699
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
0904005097
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010187991
—
VA
Enumeration date
08/08/2006
Last updated
05/12/2017
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