Provider Demographics
NPI:1265240808
Name:MISHUE, SHELBY ALISA (BSW)
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:ALISA
Last Name:MISHUE
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22184 RIVERTON RD
Mailing Address - Street 2:
Mailing Address - City:WAGRAM
Mailing Address - State:NC
Mailing Address - Zip Code:28396-8708
Mailing Address - Country:US
Mailing Address - Phone:910-506-9319
Mailing Address - Fax:
Practice Address - Street 1:1405 WEST BLVD
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-9170
Practice Address - Country:US
Practice Address - Phone:910-276-2440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker