Provider Demographics
NPI:1679204366
Name:SHEPARD, ROSEMARY (LCMHCA, LCASA)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LCMHCA, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28301-7020
Mailing Address - Country:US
Mailing Address - Phone:910-482-3332
Mailing Address - Fax:910-485-1453
Practice Address - Street 1:2931 BREEZEWOOD AVE STE 200
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-5281
Practice Address - Country:US
Practice Address - Phone:910-748-0833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC27778101YA0400X
NCA18871101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)