Healthcare Provider Details

I. General information

NPI: 1205789963
Provider Name (Legal Business Name): SHELINA RENA YOUNG PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 INDIGO AVE
RAEFORD NC
28376-5020
US

IV. Provider business mailing address

184 INDIGO AVE
RAEFORD NC
28376-5020
US

V. Phone/Fax

Practice location:
  • Phone: 910-508-2200
  • Fax:
Mailing address:
  • Phone: 910-818-7317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5024036
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: