Provider Demographics
NPI:1003827064
Name:KRAFT, SHELLEY T (LPA)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:T
Last Name:KRAFT
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 MICHAEL WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-5507
Mailing Address - Country:US
Mailing Address - Phone:919-550-4880
Mailing Address - Fax:919-845-9761
Practice Address - Street 1:312 W MILLBROOK RD
Practice Address - Street 2:SUITE 109
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-4389
Practice Address - Country:US
Practice Address - Phone:919-845-9977
Practice Address - Fax:919-845-9761
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1871103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical