Provider Demographics
NPI:1386820629
Name:SHEA, JAMES KEVIN (LPC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:KEVIN
Last Name:SHEA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7455 CROSS COUNTY RD STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-8470
Mailing Address - Country:US
Mailing Address - Phone:843-327-4444
Mailing Address - Fax:866-263-4021
Practice Address - Street 1:7455 CROSS COUNTY RD STE 6
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29418
Practice Address - Country:US
Practice Address - Phone:843-327-4444
Practice Address - Fax:866-263-4021
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-17
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X
SC5179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1760596480Medicaid