Provider Demographics
NPI:1184144339
Name:MCCABE, SHANNON MICHELE (LCAS, CSI)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MICHELE
Last Name:MCCABE
Suffix:
Gender:F
Credentials:LCAS, CSI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3280
Mailing Address - Country:US
Mailing Address - Phone:919-599-6793
Mailing Address - Fax:
Practice Address - Street 1:3325 DURHAM CHAPEL HILL BLVD STE 250
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6236
Practice Address - Country:US
Practice Address - Phone:919-599-6793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23032101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)