Fred Thomas Paul Shah, LCMHC, LCASA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

9687 Issued in NC

Practice address

610-A S. College Road
Wilmington, NC 28403-6431

Phone

(910) 796-2490

Fax

(910) 202-9966

NPI assigned

Nov 15, 2012

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Carolina Psychological and Psychiatric Health SRVS, PA

  dba Carolina Psychological Health Services

  • Psychologist
  • Jacksonville, NC
  • NPI 1770561193

  Professional

  Medicare reassignment NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1922022607

  Multi-Specialty

  Medicare reassignment NPD
• Coastal Horizons Center Inc

  • Community/Behavioral Health Agency
  • Rocky Point, NC
  • NPI 1063082592
  NPD
• Coastal Horizons Center, Inc

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1033420153

  Mental Health

  NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1790985448
  NPD
• Resolutions Counseling and Mediation Services, PLLC

  • Clinical Social Worker
  • Jacksonville, NC
  • NPI 1982868501

  Multi-Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1073857124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610-A S. COLLEGE ROAD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "28403",
            "telephone_number": "910-796-2490",
            "fax_number": "910-202-9966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610-A S. COLLEGE ROAD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284036431",
            "telephone_number": "910-796-2490",
            "fax_number": "910-202-9966"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "120 Coastal Horizons Dr",
            "address_purpose": "LOCATION",
            "city": "Shallotte",
            "state": "NC",
            "postal_code": "284706094",
            "country_code": "US",
            "telephone_number": "910-754-4515",
            "fax_number": "910-202-9966",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "309 Progress Dr",
            "address_purpose": "LOCATION",
            "city": "Burgaw",
            "state": "NC",
            "postal_code": "284253280",
            "country_code": "US",
            "telephone_number": "910-259-0668",
            "fax_number": "910-202-9966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHAH",
        "first_name": "FRED",
        "middle_name": "THOMAS PAUL",
        "name_prefix": "Mr.",
        "credential": "LCMHC, LCASA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-15",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "21403",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "9687",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "21403",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "9687",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brianna Shaffer
• Holly Candice Shaffer
• Joseph Crockett Shaffer II
• Michelle Leslie Shaffer, CCC-SLP
• Charlotte Shah, LCMHC, LCAS, CSI
• Jehan Rahim Shah, MD
• Robert M Shakar, MD
• Kendall Nicole Shalley, DPT
• Sonja Maia Shanley, M.D.
• Trevor Shannon, PHD

• Professional Counselor in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Professional Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.