Healthcare Provider Details

I. General information

NPI: 1063932432
Provider Name (Legal Business Name): CHRISTY ROBINSON SHELTON LCSWA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 05/19/2020
Certification Date: 05/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 BREVARD RD
ASHEVILLE NC
28806-2316
US

IV. Provider business mailing address

9160 FORUM CORPORATE PKWY STE 350
FORT MYERS FL
33905-7808
US

V. Phone/Fax

Practice location:
  • Phone: 828-212-7021
  • Fax:
Mailing address:
  • Phone: 866-266-0555
  • Fax: 866-266-4999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP011653
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC012409
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: