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Individual
MR. MARK SHANNON WEAVER
Active
Individual
MR. MARK SHANNON WEAVER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, LPC
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
3471
NC
101YM0800X
Mental Health Counselor
Primary
3471
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
142CE
BCBS
NC
05
—
6102622
—
NC
Enumeration date
12/14/2006
Last updated
12/02/2015
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