Provider Demographics
NPI:1174666069
Name:MOBLEY, SHELLEY WIEGMANN (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:WIEGMANN
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 QUEENS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28207-1847
Mailing Address - Country:US
Mailing Address - Phone:980-613-3400
Mailing Address - Fax:704-569-9633
Practice Address - Street 1:1001 QUEENS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1847
Practice Address - Country:US
Practice Address - Phone:980-613-3400
Practice Address - Fax:704-569-9633
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLPC 414101YM0800X
NCLMFT 421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist