Provider Demographics
NPI:1679876692
Name:MORTON, SHAWN THOMAS (M ED, NCC, LPC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:THOMAS
Last Name:MORTON
Suffix:
Gender:M
Credentials:M ED, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3169 WRIGHTSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-4184
Mailing Address - Country:US
Mailing Address - Phone:910-399-3870
Mailing Address - Fax:910-399-2506
Practice Address - Street 1:3169 WRIGHTSVILLE AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-4184
Practice Address - Country:US
Practice Address - Phone:910-399-3870
Practice Address - Fax:910-399-2506
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7633101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104671Medicaid