Provider Demographics
NPI:1508352725
Name:CARLSON, SHELBY RENEE (LPC)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:RENEE
Last Name:CARLSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 GRAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27412-5008
Mailing Address - Country:US
Mailing Address - Phone:336-334-5874
Mailing Address - Fax:336-334-3900
Practice Address - Street 1:107 GRAY DR
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27412-5008
Practice Address - Country:US
Practice Address - Phone:336-334-5874
Practice Address - Fax:336-334-3900
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11937101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor