Provider Demographics
NPI:1013403112
Name:KING, SHELBY ELIZABETH (MSED, BCBA)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:ELIZABETH
Last Name:KING
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ELIZABETH
Other - Last Name:VINING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10540
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28404
Mailing Address - Country:US
Mailing Address - Phone:919-606-7106
Mailing Address - Fax:
Practice Address - Street 1:7741 MARKET STREET
Practice Address - Street 2:SUITE C
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28411
Practice Address - Country:US
Practice Address - Phone:910-606-7106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NC103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician