Provider Demographics
NPI:1033727714
Name:SHEPHERD, DANIELLE ELIZABETH (MS, LCMHC-A, LCAS)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:ELIZABETH
Last Name:SHEPHERD
Suffix:
Gender:F
Credentials:MS, LCMHC-A, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2019 HIGHVIEW ST
Mailing Address - Street 2:
Mailing Address - City:KILL DEVIL HILLS
Mailing Address - State:NC
Mailing Address - Zip Code:27948-9325
Mailing Address - Country:US
Mailing Address - Phone:301-873-7018
Mailing Address - Fax:
Practice Address - Street 1:2224 S CROATAN HWY
Practice Address - Street 2:
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8813
Practice Address - Country:US
Practice Address - Phone:252-715-6556
Practice Address - Fax:252-715-6558
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15904101YM0800X
NCLCAS-26348101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health