Provider Demographics
NPI:1639657083
Name:JETT, SHEVONNA (LCMHC, LCAS, CSS-I)
Entity Type:Individual
Prefix:
First Name:SHEVONNA
Middle Name:
Last Name:JETT
Suffix:
Gender:F
Credentials:LCMHC, LCAS, CSS-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3315 WILKINSON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-5631
Mailing Address - Country:US
Mailing Address - Phone:704-697-0044
Mailing Address - Fax:
Practice Address - Street 1:1935 J N PEASE PL STE 104
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-4541
Practice Address - Country:US
Practice Address - Phone:704-548-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-29
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24807101YA0400X
NCA14034101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)