Provider Demographics
NPI:1023303369
Name:BIRD, SHIRLEY A (MA, LPC, LPC#1015)
Entity type:Individual
Prefix:MRS
First Name:SHIRLEY
Middle Name:A
Last Name:BIRD
Suffix:
Gender:F
Credentials:MA, LPC, LPC#1015
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:
Other - Last Name:BIRD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCMHC
Mailing Address - Street 1:3620 RUTH ST
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-7578
Mailing Address - Country:US
Mailing Address - Phone:704-819-3288
Mailing Address - Fax:
Practice Address - Street 1:325 MATTHEWS MINT HILL RD STE 102
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2889
Practice Address - Country:US
Practice Address - Phone:704-819-3288
Practice Address - Fax:704-372-1055
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-15
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1015101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health