MEDICARE: SHANNON BRENEE JUDD LCMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YP2500X	Professional Counselor	A16438	NC
3	101YM0800X	Mental Health Counselor	16438	NC

General Provider Information

NPI Number	:	1043891039
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BRENEE JUDD LCMHC

Provider Business Mailing Address
First Line	:	8536 BELLS LAKE RD
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27539-8808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9208 FALLS OF NEUSE RD STE 201
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-2438
Country	:	US
Telephone Number	:	919-277-0253
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2021
Last Update Date	:	05/15/2025

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