Basic Information
| Provider Information | |||||||||
| NPI: | 1437675683 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMAS | ||||||||
| FirstName: | SHAUN | ||||||||
| MiddleName: | PATRICK | ||||||||
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| Credential: | LPCA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5509 CREEDMOOR RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276126312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195736520 | ||||||||
| FaxNumber: | 9195736555 | ||||||||
| Practice Location | |||||||||
| Address1: | 5509 CREEDMOOR RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276126312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9195736520 | ||||||||
| FaxNumber: | 9195736555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | A12601 | NC | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.