Provider Demographics
NPI:1972144525
Name:SHORE, BRETT (MA, LCMHC)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:SHORE
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20015 SHEARER RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSON
Mailing Address - State:NC
Mailing Address - Zip Code:28036-9706
Mailing Address - Country:US
Mailing Address - Phone:704-791-5632
Mailing Address - Fax:
Practice Address - Street 1:215 S MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:DAVIDSON
Practice Address - State:NC
Practice Address - Zip Code:28036-8039
Practice Address - Country:US
Practice Address - Phone:704-765-6025
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC13184101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health