Provider Demographics
NPI:1871551465
Name:SHABE, JANICE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANICE
Middle Name:
Last Name:SHABE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11225 SALEM VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7663
Mailing Address - Country:US
Mailing Address - Phone:540-373-3223
Mailing Address - Fax:
Practice Address - Street 1:2126 JEFFERSON DAVIS HIGHWAY
Practice Address - Street 2:SUITE 103
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554
Practice Address - Country:US
Practice Address - Phone:540-658-0888
Practice Address - Fax:540-658-0855
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040029931041C0700X
VA0810005358103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA231548OtherMDIPA
VA004945123Medicaid
VA384750OtherANTHEM