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General NPI Number Information
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NPI Number | 1912450875
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Entity Type | Organization
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Legal Business Name | OAK CITY WELLNESS CENTER LLP
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Dates
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Enumeration Date | 07/27/2016
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Last Update Date | 07/27/2016
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Provider Practice Location Address
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Address Line | 2600 FAIRVIEW RD
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City | RALEIGH
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State | NC
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Zip | 27608-1384
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Country | US
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Telephone | 919-721-1766
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Fax |
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Provider Business Mailing Address
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Address Line | 1129 N BLOUNT ST
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City | RALEIGH
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State | NC
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Zip | 27604-1301
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Country | US
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Telephone | 919-721-1766
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. SHARON LYNN SHEPPARD
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Credential | MA, LMFTA
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Telephone | 919-721-1766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 11072A
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License Number State | NC
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