Healthcare Provider Details

I. General information

NPI: 1396657094
Provider Name (Legal Business Name): DEREK SHELTON COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 CAROLINA BEACH RD STE 8
WILMINGTON NC
28412-2957
US

IV. Provider business mailing address

PO BOX 15131
WILMINGTON NC
28408-5131
US

V. Phone/Fax

Practice location:
  • Phone: 910-408-2421
  • Fax:
Mailing address:
  • Phone: 910-408-2421
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DEREK SHELTON
Title or Position: OWNER/LCSW
Credential: LCSW
Phone: 910-408-2421