Healthcare Provider Details

I. General information

NPI: 1629706148
Provider Name (Legal Business Name): CHARLOTTE SHAH LCMHC, LCAS, CSI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. CHARLOTTE SCHWARTZ

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 BEXLEY DR
WILMINGTON NC
28412-2091
US

IV. Provider business mailing address

1302 BEXLEY DR
WILMINGTON NC
28412-2091
US

V. Phone/Fax

Practice location:
  • Phone: 910-508-7925
  • Fax:
Mailing address:
  • Phone: 910-508-7925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLCAS-24188
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number17936
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: