Provider Demographics
NPI:1124355045
Name:SHINN, PATSY MCMILLAN (LCAS)
Entity type:Individual
Prefix:
First Name:PATSY
Middle Name:MCMILLAN
Last Name:SHINN
Suffix:
Gender:F
Credentials:LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-316-9064
Mailing Address - Fax:704-316-9065
Practice Address - Street 1:13815 PROFESSIONAL CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078
Practice Address - Country:US
Practice Address - Phone:704-384-1320
Practice Address - Fax:704-316-3138
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1703101YA0400X
NCC0080131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6112332Medicaid
SCSW1295Medicaid
NC1124355045Medicaid
NC170W1OtherBCBS
NC6112332Medicaid