Provider Demographics
NPI:1235658063
Name:CAUSBY, SHAWN ELLEN (LCMHC, LCAS)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ELLEN
Last Name:CAUSBY
Suffix:
Gender:F
Credentials:LCMHC, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3112
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28106-3112
Mailing Address - Country:US
Mailing Address - Phone:210-607-0631
Mailing Address - Fax:
Practice Address - Street 1:5923 WAXHAW HWY
Practice Address - Street 2:
Practice Address - City:MINERAL SPRINGS
Practice Address - State:NC
Practice Address - Zip Code:28108
Practice Address - Country:US
Practice Address - Phone:210-607-0631
Practice Address - Fax:210-607-0631
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-13
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-21885101YA0400X
NC13293101YM0800X, 101YP2500X
NCA13293101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health