Provider Demographics
NPI:1558325233
Name:SHELOR-FLORES, LISA LUANNE (MSW ACSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:LUANNE
Last Name:SHELOR-FLORES
Suffix:
Gender:F
Credentials:MSW ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4443 JESSUP GROVE RD
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-9934
Mailing Address - Country:US
Mailing Address - Phone:336-547-1574
Mailing Address - Fax:336-323-5247
Practice Address - Street 1:4443 JESSUP GROVE RD
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-9934
Practice Address - Country:US
Practice Address - Phone:336-547-1574
Practice Address - Fax:336-323-5247
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0002881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7565KOtherBCBS
6237765OtherUBH
137103000OtherMAGELLAN
137103000OtherMAGELLAN