Individual
DR. SHANA MIDGETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCAS, LCMHC, LPA
Contact information
Practice address
2424 COMMERCE RD, JACKSONVILLE, NC 28546-7505
(252) 557-0444
Mailing address
2424 COMMERCE RD, JACKSONVILLE, NC 28546-7505
(252) 557-0444
(252) 557-0445
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
1853
NC
101YA0400X
Addiction (Substance Use Disorder) Counselor
1853
NC
101YM0800X
Mental Health Counselor
1853
NC
103T00000X
Psychologist
Primary
6694
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6112264
—
NC
Enumeration date
02/10/2012
Last updated
12/07/2024
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