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General NPI Number Information
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NPI Number | 1174260871
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Entity Type | Organization
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Legal Business Name | PEACEFUL SHORE THERAPY, PLLC
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Dates
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Enumeration Date | 05/16/2022
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Last Update Date | 05/16/2022
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Provider Practice Location Address
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Address Line | 11330 VANSTORY DR STE 109F
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-8146
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Country | US
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Telephone | 704-800-5405
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Fax | 833-519-1059
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Provider Business Mailing Address
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Address Line | 8012 NORMAN POINTE DR
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City | DENVER
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State | NC
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Zip | 28037-7700
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Country | US
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Telephone | 704-800-5405
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Fax | 833-513-1059
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Authorized Official
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Title or Position | OWNER, CLINICAL DIRECTOR
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Name | MARISSA SCHNELL
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Credential | LCSW, LPA
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Telephone | 719-310-9411
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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