Provider Demographics
NPI:1891991030
Name:TAYBRON, SHIRLEY EVON (MED NBCC LCMHC-S)
Entity Type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:EVON
Last Name:TAYBRON
Suffix:
Gender:F
Credentials:MED NBCC LCMHC-S
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 58531
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-8531
Mailing Address - Country:US
Mailing Address - Phone:910-864-0390
Mailing Address - Fax:910-864-0396
Practice Address - Street 1:5135 MORGANTON RD STE 102
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1525
Practice Address - Country:US
Practice Address - Phone:910-864-0390
Practice Address - Fax:910-401-1722
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCS2018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6103617Medicaid