Provider Demographics
NPI:1649611070
Name:SHEPPARD, CHERYLL ANNETTE (LPCA)
Entity type:Individual
Prefix:
First Name:CHERYLL
Middle Name:ANNETTE
Last Name:SHEPPARD
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 ST. MARY'S STREET,
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27605-1457
Mailing Address - Country:US
Mailing Address - Phone:919-608-0441
Mailing Address - Fax:919-578-3727
Practice Address - Street 1:800 ST. MARY'S ST
Practice Address - Street 2:SUITE 102
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27605-1457
Practice Address - Country:US
Practice Address - Phone:919-608-0441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10275101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCA10275OtherNC BOARD OF LICENSED PROFESSIONAL COUNSELORS