Provider Demographics
NPI:1083001895
Name:MCIVER, SHONDA
Entity Type:Individual
Prefix:
First Name:SHONDA
Middle Name:
Last Name:MCIVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 AGGIES LN
Mailing Address - Street 2:
Mailing Address - City:RAEFORD
Mailing Address - State:NC
Mailing Address - Zip Code:28376-7285
Mailing Address - Country:US
Mailing Address - Phone:910-977-8599
Mailing Address - Fax:910-904-6699
Practice Address - Street 1:225 AGGIES LN
Practice Address - Street 2:
Practice Address - City:RAEFORD
Practice Address - State:NC
Practice Address - Zip Code:28376-7285
Practice Address - Country:US
Practice Address - Phone:910-977-8599
Practice Address - Fax:910-904-6699
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-20
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)