Provider Demographics
NPI:1508628827
Name:WASSON, SHANEE (LCMHC-A, LCAS-A)
Entity Type:Individual
Prefix:
First Name:SHANEE
Middle Name:
Last Name:WASSON
Suffix:
Gender:F
Credentials:LCMHC-A, LCAS-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 SIGNAL HILL DRIVE EXT
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28625-4353
Mailing Address - Country:US
Mailing Address - Phone:704-872-0234
Mailing Address - Fax:
Practice Address - Street 1:612 SIGNAL HILL DRIVE EXT
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4353
Practice Address - Country:US
Practice Address - Phone:704-872-0234
Practice Address - Fax:980-223-8958
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA18636101YM0800X
NC29541101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health