Healthcare Provider Details

I. General information

NPI: 1174411169
Provider Name (Legal Business Name): SHILO MARIE FRANK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHILO MARIE GEORG

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 POPLAR GROVE CONNECTOR STE B
BOONE NC
28607-6121
US

IV. Provider business mailing address

284 EXECUTIVE PARK DR STE 100
CONCORD NC
28025-1833
US

V. Phone/Fax

Practice location:
  • Phone: 828-264-8759
  • Fax:
Mailing address:
  • Phone: 704-939-1100
  • Fax: 704-939-1173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-28646
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberIMH22348
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA19573
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: