Provider Demographics
NPI:1124784582
Name:DUNHAM, SHEA (LCPC, LMFT)
Entity type:Individual
Prefix:DR
First Name:SHEA
Middle Name:
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:LCPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 E LUTHER AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:NC
Mailing Address - Zip Code:27298-2616
Mailing Address - Country:US
Mailing Address - Phone:330-212-2884
Mailing Address - Fax:
Practice Address - Street 1:303 E LUTHER AVE
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:NC
Practice Address - Zip Code:27298-2616
Practice Address - Country:US
Practice Address - Phone:330-212-2884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-10
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.013309101YP2500X
IL166.001470106H00000X
NC2262106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional