Provider Demographics
NPI:1184063851
Name:BYNUM, SHALISA BYERS (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHALISA
Middle Name:BYERS
Last Name:BYNUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1404 TORREY PINES CT
Mailing Address - Street 2:
Mailing Address - City:MEBANE
Mailing Address - State:NC
Mailing Address - Zip Code:27302-7944
Mailing Address - Country:US
Mailing Address - Phone:704-582-1560
Mailing Address - Fax:
Practice Address - Street 1:1404 TORREY PINES CT
Practice Address - Street 2:
Practice Address - City:MEBANE
Practice Address - State:NC
Practice Address - Zip Code:27302-7944
Practice Address - Country:US
Practice Address - Phone:704-582-1560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0095221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical