Provider Demographics
NPI:1407734197
Name:SHORE, DAVID (CSAC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SHORE
Suffix:
Gender:M
Credentials:CSAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 JEFFERSON DR
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-2010
Mailing Address - Country:US
Mailing Address - Phone:434-422-0260
Mailing Address - Fax:
Practice Address - Street 1:4926 W BROAD ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-3122
Practice Address - Country:US
Practice Address - Phone:844-624-7513
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)