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General NPI Number Information
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NPI Number | 1265710446
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Entity Type | Individual
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Provider Name | SHANNON V ERKLIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/22/2011
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 211 E SIX FORKS RD STE 114
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City | RALEIGH
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State | NC
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Zip | 27609-7753
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Country | US
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Telephone | 919-263-4177
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Fax |
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Provider Business Mailing Address
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Address Line | 118 BERGERON WAY
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City | CARY
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State | NC
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Zip | 27519-6669
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Country | US
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Telephone | 919-263-4177
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071008673
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 5431
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License Number State | NC
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Taxonomy #4
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 071008673
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 5431
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License Number State | NC
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