Healthcare Provider Details

I. General information

NPI: 1790511582
Provider Name (Legal Business Name): SHELBY ANGELINA PARTIN LCSWA, CPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHELBY ANGELINA WONG

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3628 LEONARD RD
KNIGHTDALE NC
27545-8723
US

IV. Provider business mailing address

113 GODWIN CT
SANFORD NC
27330-9743
US

V. Phone/Fax

Practice location:
  • Phone: 919-897-7327
  • Fax:
Mailing address:
  • Phone: 984-528-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019265
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: