Provider Demographics
NPI:1205400264
Name:MASON, SHAUNA (LCAS-A)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:MASON
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:253 FAISON HWY APT 20
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3662
Mailing Address - Country:US
Mailing Address - Phone:919-273-4066
Mailing Address - Fax:
Practice Address - Street 1:253 FAISON HWY APT 20
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3662
Practice Address - Country:US
Practice Address - Phone:919-273-4066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-14
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26190101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)