Provider Demographics
NPI:1760469126
Name:SHALHOUB, JOHN ANDRAOS (LPC NCC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANDRAOS
Last Name:SHALHOUB
Suffix:
Gender:M
Credentials:LPC NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 BARN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-6707
Mailing Address - Country:US
Mailing Address - Phone:910-455-6374
Mailing Address - Fax:910-455-6374
Practice Address - Street 1:825 GUM BRANCH RD
Practice Address - Street 2:STE 122
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-6298
Practice Address - Country:US
Practice Address - Phone:910-455-6374
Practice Address - Fax:910-938-7755
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC532101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6102055Medicaid