Individual
SHELBY SOUTHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22 OLD CANAL DR, LOWELL, MA 01851-2730
(978) 452-5155
(978) 970-0713
Mailing address
1 RIVER PL, LOWELL, MA 01852-1035
(603) 997-1201
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023175072
—
MA
Enumeration date
06/03/2015
Last updated
06/03/2015
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