Provider Demographics
NPI:1346711306
Name:BYNUM, SHAPEL LUCILLE (LCMHC)
Entity Type:Individual
Prefix:
First Name:SHAPEL
Middle Name:LUCILLE
Last Name:BYNUM
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1611 KNOLL CT
Mailing Address - Street 2:
Mailing Address - City:HIGH POINT
Mailing Address - State:NC
Mailing Address - Zip Code:27265-2441
Mailing Address - Country:US
Mailing Address - Phone:336-340-4418
Mailing Address - Fax:844-444-0546
Practice Address - Street 1:3980 PREMIER DR STE 110
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-8409
Practice Address - Country:US
Practice Address - Phone:336-662-2055
Practice Address - Fax:844-444-0546
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2022-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC14071101Y00000X, 101YM0800X, 106H00000X, 101YM0800X
NC101YM0800X
NCA14071106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist