Healthcare Provider Details

I. General information

NPI: 1003363680
Provider Name (Legal Business Name): BETHANY THOMAS SHINGLETON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2016
Last Update Date: 03/09/2021
Certification Date: 03/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 MITCHELL AVE
ASHEVILLE NC
28806-2742
US

IV. Provider business mailing address

25 HAYES COVE RD
LEICESTER NC
28748-5116
US

V. Phone/Fax

Practice location:
  • Phone: 287-138-9308
  • Fax: 828-348-5739
Mailing address:
  • Phone: 252-236-5189
  • Fax: 828-348-5739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012663
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: