Healthcare Provider Details

I. General information

NPI: 1154232825
Provider Name (Legal Business Name): KINSHIRO PAUL SHIMOCHI LMFT-A
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5716 FAYETTEVILLE RD STE 203
DURHAM NC
27713-9662
US

IV. Provider business mailing address

6604 SIX FORKS RD STE 101
RALEIGH NC
27615-6521
US

V. Phone/Fax

Practice location:
  • Phone: 984-235-2545
  • Fax: 844-253-4789
Mailing address:
  • Phone: 984-235-2545
  • Fax: 844-253-4789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number21296A
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: