Individual
MRS. DEMETRIOUS THOMAS SHEPARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
824 GUM BRANCH RD STE E, JACKSONVILLE, NC 28540-6270
(910) 327-1694
(910) 347-3694
Mailing address
520 OLD CHADWICK LANE, JACKSONVILLE, NC 28540
(910) 347-1694
(910) 347-3694
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4611
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1378X
BCBS
NC
05
—
6102002
—
NC
Enumeration date
12/26/2006
Last updated
07/31/2012
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