Provider Demographics
NPI:1316919921
Name:SHELTON-RIEK, KATHY M (MSW, EDS)
Entity type:Individual
Prefix:MS
First Name:KATHY
Middle Name:M
Last Name:SHELTON-RIEK
Suffix:
Gender:F
Credentials:MSW, EDS
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 1986
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28145-1986
Mailing Address - Country:US
Mailing Address - Phone:704-639-9889
Mailing Address - Fax:
Practice Address - Street 1:420 STATESVILLE BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2318
Practice Address - Country:US
Practice Address - Phone:704-639-9889
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0015241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC71657OtherBLUE CROSS AND BLUE SHIEL
NC60-02058Medicaid
NC71657OtherBLUE CROSS AND BLUE SHIEL