Provider Demographics
NPI:1427163088
Name:SHEPARD, CAROL ANNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANNE
Last Name:SHEPARD
Suffix:
Gender:F
Credentials:LMFT
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 1216
Mailing Address - Street 2:
Mailing Address - City:SWANSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28584-1216
Mailing Address - Country:US
Mailing Address - Phone:910-326-8881
Mailing Address - Fax:
Practice Address - Street 1:714 W CORBETT AVE STE 22
Practice Address - Street 2:
Practice Address - City:SWANSBORO
Practice Address - State:NC
Practice Address - Zip Code:28584-8437
Practice Address - Country:US
Practice Address - Phone:910-326-8881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC755106H00000X
CA31403106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist