Provider Demographics
NPI:1487393427
Name:SHEPARDSON, EMMA BETTY (LCSW)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:BETTY
Last Name:SHEPARDSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:EMMA
Other - Middle Name:BETTY
Other - Last Name:CALVERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:217 OVERSTONE CT
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-5015
Mailing Address - Country:US
Mailing Address - Phone:913-957-1732
Mailing Address - Fax:
Practice Address - Street 1:3150 CITY CHURCH ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28056-0045
Practice Address - Country:US
Practice Address - Phone:913-957-1732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC.16584CP1041C0700X
NCC0158991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical