Provider Demographics
NPI:1841710803
Name:SHULER-THURMAN, DAPHNE S (LCAS-A)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:S
Last Name:SHULER-THURMAN
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 MEDLO RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-2527
Mailing Address - Country:US
Mailing Address - Phone:910-578-5977
Mailing Address - Fax:
Practice Address - Street 1:804 MEDLO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-2527
Practice Address - Country:US
Practice Address - Phone:910-578-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-21
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-22017101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty