Healthcare Provider Details

I. General information

NPI: 1902097116
Provider Name (Legal Business Name): WENDY E. SHOUSE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 WH SMITH BLVD
GREENVILLE NC
27834-5052
US

IV. Provider business mailing address

PO BOX 751069
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-816-5150
  • Fax: 252-816-5151
Mailing address:
  • Phone: 252-744-3258
  • Fax: 252-744-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1121
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: