Provider Demographics
NPI:1417241191
Name:ROYAL, SHEILA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:ROYAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:DIANE
Other - Last Name:THORP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:601 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-2939
Mailing Address - Country:US
Mailing Address - Phone:336-748-4025
Mailing Address - Fax:336-748-4108
Practice Address - Street 1:601 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-2939
Practice Address - Country:US
Practice Address - Phone:336-748-4025
Practice Address - Fax:336-748-4108
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-31
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical