Individual
MR. FRED THOMAS PAUL SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCMHC, LCASA
Contact information
Practice address
610-A S. COLLEGE ROAD, WILMINGTON, NC 28403-6431
(910) 796-2490
(910) 202-9966
Mailing address
610-A S. COLLEGE ROAD, WILMINGTON, NC 28403
(910) 796-2490
(910) 202-9966
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
21403
NC
101YM0800X
Mental Health Counselor
9687
NC
101YP2500X
Professional Counselor
21403
NC
101YP2500X
Professional Counselor
Primary
9687
NC
Other
Enumeration date
11/15/2012
Last updated
09/06/2022
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