Provider Demographics
NPI:1366060402
Name:SHELTON, MARIE LUISE (LCMHCA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:LUISE
Last Name:SHELTON
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 S CROATAN HWY
Mailing Address - Street 2:D7, PMB 21
Mailing Address - City:NAGS HEAD
Mailing Address - State:NC
Mailing Address - Zip Code:27959-8813
Mailing Address - Country:US
Mailing Address - Phone:252-255-2733
Mailing Address - Fax:252-255-0787
Practice Address - Street 1:2224 S CROATAN HWY
Practice Address - Street 2:D7, PMB 21
Practice Address - City:NAGS HEAD
Practice Address - State:NC
Practice Address - Zip Code:27959-8813
Practice Address - Country:US
Practice Address - Phone:252-255-2733
Practice Address - Fax:252-255-0787
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA15824101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional