| Doctor Name: | LILLY MARIE SHORTER |
| NPI Number: | 1154715027 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LCAS 21705 |
| License Number: | LCAS 21705 |
| Business Practice Address: | 110 South West Center St. Mount Olive, NC - 283652124 |
| Business Phone Number: | 9196353344 |
| Business Fax Number: | 9196353388 |
| Mailing Address: | 110 South West Center St., MOUNT OLIVE |
| State: | NC |
| Postal Code: | 283652124 |
| Phone Number: | 9196353344 |
| Fax Number: | 9196353388 |
| NPI Enumeration Date: | 03/27/2015 |
| NPI Last Update Date: | 03/27/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | LCAS 21705 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NC |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |