Provider Demographics
NPI:1770612178
Name:SHALLOW, SHARON JONES (MAED,LPC, LMFT,)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:JONES
Last Name:SHALLOW
Suffix:
Gender:F
Credentials:MAED,LPC, LMFT,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 COUNTRY CLUB DR STE G
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-6124
Mailing Address - Country:US
Mailing Address - Phone:252-355-1764
Mailing Address - Fax:
Practice Address - Street 1:601 COUNTRY CLUB DR STE G
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-6124
Practice Address - Country:US
Practice Address - Phone:252-355-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-04
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC091106H00000X
NC1172101YA0400X
NC2219101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC75417OtherBLUE CROSS BLUE SHIELD