Individual
SHASTA GABRIELLE STATEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MED, LPC
Contact information
Practice address
5200 PARK RD STE 218B, CHARLOTTE, NC 28209-3650
(866) 700-1606
Mailing address
12664 PERSIMMON TREE DR, CHARLOTTE, NC 28273-8024
(704) 621-1095
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
9182
NC
Other
Enumeration date
12/07/2012
Last updated
06/23/2021
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