Provider Demographics
NPI:1487124558
Name:EURING, MYSHALAE JAMERSON (PHD, LCMHC, CRC, NCC)
Entity type:Individual
Prefix:DR
First Name:MYSHALAE
Middle Name:JAMERSON
Last Name:EURING
Suffix:
Gender:F
Credentials:PHD, LCMHC, CRC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 GLEN OAKS RD
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-9072
Mailing Address - Country:US
Mailing Address - Phone:252-493-6739
Mailing Address - Fax:
Practice Address - Street 1:1384 GLEN OAKS RD
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-9072
Practice Address - Country:US
Practice Address - Phone:252-493-6739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00119505225C00000X
NC11464101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorGroup - Single Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty