MEDICARE: MRS. SHIRLEY EVON TAYBRON MED. NBCC LCMHC-S

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	101YM0800X	Mental Health Counselor	S2018	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891991030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHIRLEY EVON TAYBRON MED. NBCC LCMHC-S

Provider Business Mailing Address
First Line	:	PO BOX 58531
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28305-8531
Country	:	US
Telephone Number	:	910-864-0390
Fax Number	:	910-864-0396

Provider Business Practice Location Address
First Line	:	5135 MORGANTON RD STE 102
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28314-1525
Country	:	US
Telephone Number	:	910-864-0390
Fax Number	:	910-401-1722

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	11/23/2020

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Directions to “ MRS. SHIRLEY EVON TAYBRON MED. NBCC LCMHC-S” Practice Location

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