Provider Demographics
NPI:1215307665
Name:ASA, NICHOLAS SHAWN (MA, NCC, LPCA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:SHAWN
Last Name:ASA
Suffix:
Gender:M
Credentials:MA, NCC, LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 FOXBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-5771
Mailing Address - Country:US
Mailing Address - Phone:704-607-0509
Mailing Address - Fax:
Practice Address - Street 1:900 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2433
Practice Address - Country:US
Practice Address - Phone:704-721-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11436101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional