Provider Demographics
NPI:1144586017
Name:SHIFTING PARADIGMS COUNSELING AND CONSULTING, PC
Entity Type:Organization
Organization Name:SHIFTING PARADIGMS COUNSELING AND CONSULTING, PC
Other - Org Name:SHIFTING PARADIGMS COUNSELING AND CONSULTING, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FORENSIC PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LISW-CP, CCSOT
Authorized Official - Phone:704-491-3097
Mailing Address - Street 1:PO BOX 178
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120-0178
Mailing Address - Country:US
Mailing Address - Phone:704-491-3097
Mailing Address - Fax:704-625-7129
Practice Address - Street 1:9635 SOUTHERN PINE BLVD STE 127
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-5563
Practice Address - Country:US
Practice Address - Phone:704-207-0423
Practice Address - Fax:704-625-7129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-05
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC005677251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6007186Medicaid