Provider Demographics
NPI:1811357429
Name:MOORE-GETER, SHAWANNA NICOLE (LCMHC)
Entity type:Individual
Prefix:
First Name:SHAWANNA
Middle Name:NICOLE
Last Name:MOORE-GETER
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 1:900 OLD WINSTON RD STE 104
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-9965
Mailing Address - Country:US
Mailing Address - Phone:336-682-5982
Mailing Address - Fax:336-579-0507
Practice Address - Street 1:900 OLD WINSTON RD STE 104
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-9965
Practice Address - Country:US
Practice Address - Phone:336-682-5982
Practice Address - Fax:336-579-0507
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-25
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12131101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1730710328OtherGROUP NPI
NC1811357429OtherNPI