Provider Demographics
NPI:1871831131
Name:MOFFITT, SHAWN W (LCMHC, LCAS, NCC)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:W
Last Name:MOFFITT
Suffix:
Gender:F
Credentials:LCMHC, LCAS, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 CHALET DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-7767
Mailing Address - Country:US
Mailing Address - Phone:919-309-6569
Mailing Address - Fax:
Practice Address - Street 1:110 CHALET DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-7767
Practice Address - Country:US
Practice Address - Phone:919-309-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-22
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS-3442101YA0400X
NC10345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)