Provider Demographics
NPI:1659859940
Name:MYERS, SHAMBRI LENEE PERRY (LCSW, CSAC)
Entity type:Individual
Prefix:MRS
First Name:SHAMBRI
Middle Name:LENEE PERRY
Last Name:MYERS
Suffix:
Gender:F
Credentials:LCSW, CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 HOLLY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325-4691
Mailing Address - Country:US
Mailing Address - Phone:757-417-9508
Mailing Address - Fax:
Practice Address - Street 1:4560 SOUTH BLVD STE 300
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1160
Practice Address - Country:US
Practice Address - Phone:757-228-5635
Practice Address - Fax:757-223-0327
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040104201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0710103052OtherCERTIFIED SUBSTANCE ABUSE COUNSELOR
VA0904010420OtherLICENSED CLINICAL SOCIAL WORKER