Provider Demographics
NPI:1508326869
Name:SHEPPARD, SHATARA LEANN (LPCA,)
Entity Type:Individual
Prefix:MRS
First Name:SHATARA
Middle Name:LEANN
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LPCA,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORDTON
Mailing Address - State:NC
Mailing Address - Zip Code:28139-0253
Mailing Address - Country:US
Mailing Address - Phone:828-337-0808
Mailing Address - Fax:
Practice Address - Street 1:4 LONG SHOALS RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-5544
Practice Address - Country:US
Practice Address - Phone:828-337-0808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-22
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA14696101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty