Provider Demographics
NPI:1447403910
Name:DAVID, SHIRLEY (MS LLP LCAS SAP)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:DAVID
Suffix:
Gender:F
Credentials:MS LLP LCAS SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 CHARLION DOWNS LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-6488
Mailing Address - Country:US
Mailing Address - Phone:919-623-4384
Mailing Address - Fax:919-362-4390
Practice Address - Street 1:800 W WILLIAMS ST
Practice Address - Street 2:SUITE 231-O
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-6488
Practice Address - Country:US
Practice Address - Phone:919-623-4384
Practice Address - Fax:919-362-4390
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1231101YA0400X
MI6301006758103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical