Active NPI
Shirley O. Conklin, LPC
- Counselor
- Chesapeake, VA
National Provider Identifier
1194804575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- 0701003283
- Practice address
- 224 Great Bridge Blvd
Chesapeake, VA 23320-3904 - Phone
- (757) 547-9334
- Fax
- (757) 819-6292
- NPI assigned
- Nov 4, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | 0701003283 | VA | Primary |
| Counselor | 101Y00000X | 0701003283LPC | VA |
Addresses
Primary practice location
224 Great Bridge Blvd
Chesapeake, VA 23320-3904
Mailing address
224 Great Bridge Blvd
Chesapeake, VA 23320-3904
Phone (757) 547-9334
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 143676 | Other | VA | ANTHEM TRIGON |
| 484893000 | Other | VA | MAGELLAN HEALTH |
| 089111 | Other | VA | OPTIMA/SENTARA |
| 518306 | Other | VA | VALUE OPTIONS |
| 343506 | Other | VA | FED HEALTH NET TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0701003283 | VA | MD | Counselor |
| 0701003283LPC | VA | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162598400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378339200000",
"number": "1194804575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "224 GREAT BRIDGE BLVD",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233203904",
"telephone_number": "757-547-9334",
"fax_number": "757-819-6292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "224 GREAT BRIDGE BLVD",
"city": "CHESAPEAKE",
"state": "VA",
"postal_code": "233203904",
"telephone_number": "757-547-9334",
"fax_number": "757-819-6292"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONKLIN",
"first_name": "SHIRLEY",
"middle_name": "O.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-11-04",
"last_updated": "2013-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0701003283",
"primary": true
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "VA",
"license": "0701003283LPC",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM TRIGON",
"identifier": "143676",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN HEALTH",
"identifier": "484893000",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OPTIMA/SENTARA",
"identifier": "089111",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "518306",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FED HEALTH NET TRICARE",
"identifier": "343506",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chesapeake, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.