Provider Demographics
NPI:1093907636
Name:ROBERSON, SHAWN DENISE (LPC)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:DENISE
Last Name:ROBERSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3530 HEATHROW DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27127-4672
Mailing Address - Country:US
Mailing Address - Phone:336-391-3987
Mailing Address - Fax:
Practice Address - Street 1:615 ST GEORGE SQUARE CT
Practice Address - Street 2:SUITE 300
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-1365
Practice Address - Country:US
Practice Address - Phone:336-701-2713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7721101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional