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General NPI Number Information
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NPI Number | 1891991030
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Entity Type | Individual
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Provider Name | SHIRLEY EVON TAYBRON MED. NBCC LCMHC-S
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 11/23/2020
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Provider Practice Location Address
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Address Line | 5135 MORGANTON RD STE 102
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City | FAYETTEVILLE
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State | NC
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Zip | 28314-1525
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Country | US
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Telephone | 910-864-0390
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Fax | 910-401-1722
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Provider Business Mailing Address
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Address Line | PO BOX 58531
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City | FAYETTEVILLE
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State | NC
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Zip | 28305-8531
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Country | US
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Telephone | 910-864-0390
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Fax | 910-864-0396
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | S2018
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License Number State | NC
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