Individual
SHIRLEY HART
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DIRECTOR
Contact information
Practice address
708 N JACKSON ST, RAEFORD, NC 28376-2218
(910) 273-6137
Mailing address
116 E ELWOOD AVE, RAEFORD, NC 28376-2940
(910) 273-6137
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
57-1203135
—
NC
Enumeration date
06/24/2020
Last updated
06/24/2020
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