Basic Information
| Provider Information | |||||||||
| NPI: | 1104315977 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PERRY | ||||||||
| FirstName: | SHEILA | ||||||||
| MiddleName: | FAY | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1405 PRESIDIO LN | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278345276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2522588537 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 231 COMMERCE ST | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278585029 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2523218080 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2018 | ||||||||
| LastUpdateDate: | 01/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A13863 | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | A13863 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.