Provider Demographics
NPI:1326434432
Name:SHEA, MARY MOUSSA (LMFTA)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MOUSSA
Last Name:SHEA
Suffix:
Gender:F
Credentials:LMFTA
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:FATEEN
Other - Last Name:MOUSSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1935 J N PEASE PL
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-4554
Mailing Address - Country:US
Mailing Address - Phone:704-750-1570
Mailing Address - Fax:
Practice Address - Street 1:1935 J N PEASE PL
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4554
Practice Address - Country:US
Practice Address - Phone:704-750-1570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10047A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist