Provider Demographics
NPI:1003221318
Name:LUCAS, SHANNELL (LCMHC, LCAS, CCS, QS)
Entity Type:Individual
Prefix:
First Name:SHANNELL
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CCS, QS
Other - Prefix:
Other - First Name:SHANNELL
Other - Middle Name:
Other - Last Name:LUCAS-MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRC, LPC, LCAS
Mailing Address - Street 1:3816 N ELM ST STE C
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27455-2776
Mailing Address - Country:US
Mailing Address - Phone:336-545-5995
Mailing Address - Fax:
Practice Address - Street 1:3816 N ELM ST STE C
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27455-2776
Practice Address - Country:US
Practice Address - Phone:336-545-5995
Practice Address - Fax:336-545-5996
Is Sole Proprietor?:No
Enumeration Date:2014-06-25
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20858101YA0400X
NC11087101YP2500X, 101YM0800X
00118288225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor