Individual
LILLY MARIE SHORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS 21705
Contact information
Practice address
86 THREE HUNT DRIVE, PEMBROKE, NC 28372
(910) 522-0408
Mailing address
116 GRANGER RD, RAEFORD, NC 28376-8060
(910) 578-3134
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LCAS 21705
NC
Other
Enumeration date
03/27/2015
Last updated
05/23/2018
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