Basic Information
| Provider Information | |||||||||
| NPI: | 1871551465 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHABE | ||||||||
| FirstName: | JANICE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11225 SALEM VILLAGE DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224077663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5403733223 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2126 JEFFERSON DAVIS HIGHWAY | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | STAFFORD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5406580888 | ||||||||
| FaxNumber: | 5406580855 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 02/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 0904002993 | VA | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 103TC0700X | 0810005358 | VA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 231548 | 01 | VA | MDIPA | OTHER | 004945123 | 05 | VA | MEDICAID | 384750 | 01 | VA | ANTHEM | OTHER |