MEDICARE: MARIAM SHAAT LCMHC-A

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	101YM0800X	Mental Health Counselor	A22453	NC

General Provider Information

NPI Number	:	1720946171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAM SHAAT LCMHC-A

Provider Business Mailing Address
First Line	:	205 REGENCY EXECUTIVE PARK DR STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2968
Country	:	US
Telephone Number	:	980-939-0991
Fax Number	:	704-731-0980

Provider Business Practice Location Address
First Line	:	205 REGENCY EXECUTIVE PARK DR STE 210
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28217-2968
Country	:	US
Telephone Number	:	980-939-0991
Fax Number	:	704-731-0980

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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