Provider Demographics
NPI:1902097116
Name:SHOUSE, WENDY E (LMFT)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:E
Last Name:SHOUSE
Suffix:
Gender:F
Credentials:LMFT
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 751069
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1069
Mailing Address - Country:US
Mailing Address - Phone:252-744-3258
Mailing Address - Fax:252-744-3194
Practice Address - Street 1:2303 EXECUTIVE CIR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-3749
Practice Address - Country:US
Practice Address - Phone:252-744-8334
Practice Address - Fax:252-744-8335
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1121106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist