Provider Demographics
NPI:1346561362
Name:SHEPARD, KEVIN MCCRAE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MCCRAE
Last Name:SHEPARD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COUNSELING AND WELLNESS SERVICES
Mailing Address - Street 2:CAMPUS BOX 7470
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-7470
Mailing Address - Country:US
Mailing Address - Phone:919-966-3658
Mailing Address - Fax:919-966-4605
Practice Address - Street 1:COUNSELING AND WELLNESS SERVICES
Practice Address - Street 2:CAMPUS BOX 7470
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27599-7470
Practice Address - Country:US
Practice Address - Phone:919-966-3658
Practice Address - Fax:919-966-4605
Is Sole Proprietor?:No
Enumeration Date:2010-06-14
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3450103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling