Basic Information
| Provider Information | |||||||||
| NPI: | 1831487727 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | STUART-SHOR | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | PAIGE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | WESTER | ||||||||
| OtherFirstName: | JESSICA | ||||||||
| OtherMiddleName: | PAIGE | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | MA, LPC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 805 WESTMONT DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283054555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104844061 | ||||||||
| FaxNumber: | 9104854069 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 WESTMONT DR | ||||||||
| Address2: | |||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 283054555 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9104844061 | ||||||||
| FaxNumber: | 9104854069 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2011 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 8627 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.