Provider Demographics
NPI:1073578027
Name:DRENNEN, SHEILA K (MSW)
Entity Type:Individual
Prefix:MISS
First Name:SHEILA
Middle Name:K
Last Name:DRENNEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MISS
Other - First Name:SHEILA
Other - Middle Name:K
Other - Last Name:DRENNEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 1805
Mailing Address - Street 2:624 VILLAGE RD. , SUITE 1A
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28459-1805
Mailing Address - Country:US
Mailing Address - Phone:910-755-6563
Mailing Address - Fax:910-755-6565
Practice Address - Street 1:624 VILLAGE RD.
Practice Address - Street 2:SUITE 1A
Practice Address - City:SHALLOTE
Practice Address - State:NC
Practice Address - Zip Code:28459
Practice Address - Country:US
Practice Address - Phone:910-755-6563
Practice Address - Fax:910-755-6565
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0035791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12774OtherBLUE CROSS/BLUE SHIELD
NC6002687Medicaid
NC2873405AMedicare ID - Type Unspecified