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General NPI Number Information
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NPI Number | 1306564430
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Entity Type | Individual
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Provider Name | SHAUNTE L PRALOUR LCSWA
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Gender | Female
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Dates
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Enumeration Date | 08/15/2022
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Last Update Date | 08/16/2022
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Provider Practice Location Address
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Address Line | 1923 J N PEASE PL STE 104
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City | CHARLOTTE
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State | NC
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Zip | 28262-4534
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Country | US
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Telephone | 704-802-7576
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Fax |
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Provider Business Mailing Address
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Address Line | 3016 SAPHIRE LN
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-5553
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Country | US
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Telephone | 803-606-3930
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P017434
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | P017434
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License Number State | NC
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