Provider Demographics
NPI:1124579834
Name:FERRESE, SHAUNA (PHD, LPC-S, LAC, NCC)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:FERRESE
Suffix:
Gender:F
Credentials:PHD, LPC-S, LAC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 ASHLEY RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5902
Mailing Address - Country:US
Mailing Address - Phone:843-556-8177
Mailing Address - Fax:
Practice Address - Street 1:1620 ASHLEY RIVER RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5902
Practice Address - Country:US
Practice Address - Phone:843-556-8177
Practice Address - Fax:843-571-2742
Is Sole Proprietor?:No
Enumeration Date:2016-10-18
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC194101YA0400X
SC9099101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)