MEDICARE: MS. SHIRLEY A SCHWARHA LCAS-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2440-A	NC

General Provider Information

NPI Number	:	1780005553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY A SCHWARHA LCAS-A

Provider Business Mailing Address
First Line	:	4805 GREEN RD
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-872-6220
Fax Number	:	919-872-6223

Provider Business Practice Location Address
First Line	:	4805 GREEN RD
Second Line	:	SUITE 103
City	:	RALEIGH
State	:	NC
Zip	:	27616-2848
Country	:	US
Telephone Number	:	919-872-6220
Fax Number	:	919-872-6223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/22/2013
Last Update Date	:	12/22/2013

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