Provider Demographics
NPI:1033828207
Name:SHIVERS, CELENA NICOLE (PMHNP)
Entity Type:Individual
Prefix:MRS
First Name:CELENA
Middle Name:NICOLE
Last Name:SHIVERS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:CELENA
Other - Middle Name:NICOLE
Other - Last Name:UPCHURCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6037 LANDRY LN
Mailing Address - Street 2:
Mailing Address - City:INDIAN LAND
Mailing Address - State:SC
Mailing Address - Zip Code:29707-6060
Mailing Address - Country:US
Mailing Address - Phone:803-979-6171
Mailing Address - Fax:704-817-1470
Practice Address - Street 1:10430 HARRIS OAK BLVD STE L
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28269-7513
Practice Address - Country:US
Practice Address - Phone:704-317-2930
Practice Address - Fax:704-644-2513
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-16
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10011737163WP0808X
AZ294831163WP0808X
NC5017424363LP0808X
SC205549163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health