Provider Demographics
NPI:1659118164
Name:WARREN, SHAWN C
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:C
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1063 YATES RD
Mailing Address - Street 2:
Mailing Address - City:WALNUT COVE
Mailing Address - State:NC
Mailing Address - Zip Code:27052-6583
Mailing Address - Country:US
Mailing Address - Phone:609-289-3816
Mailing Address - Fax:
Practice Address - Street 1:8311 BRIER CREEK PKWY STE 105-501
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7328
Practice Address - Country:US
Practice Address - Phone:787-833-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician