Healthcare Provider Details

I. General information

NPI: 1093948341
Provider Name (Legal Business Name): RONALD SHEDRICK CAPEL CARF
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2009
Last Update Date: 09/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 E CASWELL ST
WADESBORO NC
28170-2375
US

IV. Provider business mailing address

1007 EAST CASWELL ST
WADESBORO NC
28170-2375
US

V. Phone/Fax

Practice location:
  • Phone: 704-994-2797
  • Fax: 800-948-0651
Mailing address:
  • Phone: 704-994-2797
  • Fax: 800-948-0651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3245S0500X
TaxonomyChildren's Substance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: