Provider Demographics
NPI:1750733739
Name:GUTSCHICK, SHANNON (LCMHC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:GUTSCHICK
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 NAPA RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27295-6398
Mailing Address - Country:US
Mailing Address - Phone:704-699-9272
Mailing Address - Fax:
Practice Address - Street 1:136 NAPA RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27295-6398
Practice Address - Country:US
Practice Address - Phone:704-699-9272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-01
Last Update Date:2023-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11921101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1750733739Medicaid