Healthcare Provider Details

I. General information

NPI: 1932497641
Provider Name (Legal Business Name): JAMES SNYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2011
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N LAFAYETTE ST STE 1-1
SHELBY NC
28150-5686
US

IV. Provider business mailing address

809 N LAFAYETTE ST STE G
SHELBY NC
28150-3886
US

V. Phone/Fax

Practice location:
  • Phone: 704-220-2370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8728
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA8728
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: