Provider Demographics
NPI:1871647727
Name:SHEPPARD, CYNTHIA (MS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CENTERVIEW DR
Mailing Address - Street 2:SUITE 50
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-3717
Mailing Address - Country:US
Mailing Address - Phone:336-273-7371
Mailing Address - Fax:336-273-5050
Practice Address - Street 1:2 CENTERVIEW DR
Practice Address - Street 2:SUITE 50
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-3717
Practice Address - Country:US
Practice Address - Phone:336-273-7371
Practice Address - Fax:336-273-5050
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC46346OtherNATIONAL CERTIFIED COUNSE
NC2835OtherSTATE LICENSE #
NC46346OtherNATIONAL CERTIFIED COUNSE