Provider Demographics
NPI:1275742157
Name:SHOOK, JEFFRY S (MED, LPC)
Entity Type:Individual
Prefix:MR
First Name:JEFFRY
Middle Name:S
Last Name:SHOOK
Suffix:
Gender:M
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10734 SPRUCE KNOB LN
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28214-8632
Mailing Address - Country:US
Mailing Address - Phone:704-608-6919
Mailing Address - Fax:
Practice Address - Street 1:1923 J N PEASE PL STE 204
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4535
Practice Address - Country:US
Practice Address - Phone:704-503-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3328101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor