Basic Information
| Provider Information | |||||||||
| NPI: | 1033827084 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DURANT | ||||||||
| FirstName: | SHIRBY | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSWA, LCASA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 217 CAROLINA FOREST BLVD APT 4-105 | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285469396 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432293759 | ||||||||
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| Practice Location | |||||||||
| Address1: | 231 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9103535354 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2022 | ||||||||
| LastUpdateDate: | 11/08/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | P018360 | NC | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | 20415 | NC | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.