Provider Demographics
NPI:1801426291
Name:SHUFORD, PATRICE NICOLE
Entity type:Individual
Prefix:MS
First Name:PATRICE
Middle Name:NICOLE
Last Name:SHUFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FLOWER CIR
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-4613
Mailing Address - Country:US
Mailing Address - Phone:804-919-0364
Mailing Address - Fax:
Practice Address - Street 1:1430 FARMER ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-3941
Practice Address - Country:US
Practice Address - Phone:804-919-0364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0704007639101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health