Provider Demographics
NPI:1306213475
Name:SHORTS, CARLA
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:SHORTS
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 1:16 SWISS VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:OTTO
Mailing Address - State:NC
Mailing Address - Zip Code:28763-8719
Mailing Address - Country:US
Mailing Address - Phone:828-349-4581
Mailing Address - Fax:801-437-2984
Practice Address - Street 1:16 SWISS VILLAGE RD
Practice Address - Street 2:
Practice Address - City:OTTO
Practice Address - State:NC
Practice Address - Zip Code:28763-8719
Practice Address - Country:US
Practice Address - Phone:828-349-4581
Practice Address - Fax:801-437-2984
Is Sole Proprietor?:No
Enumeration Date:2015-08-25
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional