Individual
JACLYN SURLES SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4 HOSPITAL DR, CHARLOTTESVILLE, VA 22908-0001
(434) 924-5314
(434) 924-0185
Mailing address
PO BOX 9007, CHARLOTTESVILLE, VA 22906-9007
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
0810004538
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/10/2009
Last updated
07/11/2012
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