Healthcare Provider Details

I. General information

NPI: 1982220729
Provider Name (Legal Business Name): ANNA REEVES SHEPHERD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2020
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 KINGDOM WAY STE 100
RALEIGH NC
27607-6063
US

IV. Provider business mailing address

178 KEITH WEATHERS RD
FUQUAY VARINA NC
27526-7477
US

V. Phone/Fax

Practice location:
  • Phone: 800-442-2762
  • Fax:
Mailing address:
  • Phone: 336-984-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6776
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-20-41871
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: