Healthcare Provider Details

I. General information

NPI: 1396545596
Provider Name (Legal Business Name): YVETTE SHELTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

242 E BROAD ST
STATESVILLE NC
28677-5325
US

IV. Provider business mailing address

242 E BROAD ST
STATESVILLE NC
28677-5325
US

V. Phone/Fax

Practice location:
  • Phone: 980-430-9205
  • Fax: 704-799-8949
Mailing address:
  • Phone: 980-430-9205
  • Fax: 704-799-8949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA14641
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: