Provider Demographics
NPI:1528555398
Name:SHOULARS, TRAVIS ANTONIO (MS, MPA, LPCA, NCC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:ANTONIO
Last Name:SHOULARS
Suffix:
Gender:M
Credentials:MS, MPA, LPCA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 CAMDEN CT
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-9077
Mailing Address - Country:US
Mailing Address - Phone:252-339-3804
Mailing Address - Fax:
Practice Address - Street 1:100 ELM ST
Practice Address - Street 2:
Practice Address - City:WELDON
Practice Address - State:NC
Practice Address - Zip Code:27890-1934
Practice Address - Country:US
Practice Address - Phone:252-537-4005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA13915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health