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NPI Code Detail

MEDICARE: DR. SHANA MIDGETTE LCAS, LCMHC, LPA

MEDICARE: DR. SHANA MIDGETTE LCAS, LCMHC, LPA
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
1101YM0800XMental Health Counselor1853NC
2103T00000XPsychologist6694NC
3101Y00000XCounselor1853NC
4101YA0400XAddiction (Substance Use Disorder) Counselor1853NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659644383
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHANA MIDGETTE LCAS, LCMHC, LPA
Provider Business Mailing Address
First Line : 2424 COMMERCE RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-7505
Country : US
Telephone Number : 252-557-0444
Fax Number : 252-557-0445
Provider Business Practice Location Address
First Line : 2424 COMMERCE RD
Second Line :
City : JACKSONVILLE
State : NC
Zip : 28546-7505
Country : US
Telephone Number : 252-557-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/10/2012
Last Update Date : 12/07/2024

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