Provider Demographics
NPI:1154637239
Name:SHAVE, KYLE (MSW, P-LCSW)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:SHAVE
Suffix:
Gender:M
Credentials:MSW, P-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 MILLSTONE DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-9056
Mailing Address - Country:US
Mailing Address - Phone:919-316-8126
Mailing Address - Fax:
Practice Address - Street 1:500 MILLSTONE DR STE 104
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9056
Practice Address - Country:US
Practice Address - Phone:919-316-8126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP005808OtherNORTH CAROLINA SOCIAL WORK CERTIFICATION AND LICENSURE BOARD