Daniel Watkins Shattuck, PH.D., LCMHC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

3398 Issued in NC

Practice address

2501 Atrium Dr Ste 100
Raleigh, NC 27607-6452

Phone

(919) 763-2760

Fax

(919) 359-9705

NPI assigned

May 20, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1148083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1558315820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 ATRIUM DR STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076452",
            "telephone_number": "919-763-2760",
            "fax_number": "919-359-9705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 ATRIUM DR STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276076452",
            "telephone_number": "919-763-2760",
            "fax_number": "919-359-9705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHATTUCK",
        "first_name": "DANIEL",
        "middle_name": "WATKINS",
        "name_prefix": "Mr.",
        "credential": "PH.D., LCMHC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-20",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "3398",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "3398",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6102454",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDCOST PREFERRED",
            "identifier": "E0478",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIEL",
            "identifier": "75888",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Lea Sharpe, DNP, APRN, FNP
• Rosellar Sharper, C.N.A / M.A
• Jireh S Sharpless
• Lauren Sharpless, PT, DPT
• Amie Lynn Sharrits, M.D.
• Joseph Tillman Shaughnessy, DC
• Andrew Michael Shaw, LCMHC
• Annie Laverne Cummings Shaw, LPC
• Danielle Shaw
• Kim Shaw

• Mental Health Counselor in Raleigh, NC
• Providers in Raleigh, NC by specialty
• Mental Health Counselor in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.