Weaver, Mark Shannon

Weaver, Mark Shannon is an sole proprietor health care provider with primary practice located at 2000 Yonkers Rd , Raleigh NC 27604-2258. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Counselor, Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Mental Health is his primary health care specialty. Weaver, Mark Shannon can be contacted via phone (919) 896-7536.

Contact Information

Primary practice address
2000 Yonkers Rd Raleigh NC 27604-2258
Phone: (919) 896-7536
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Counselor 101Y00000X 3471 North Carolina
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 3471 North Carolina

Profile Details

NPI number 1508928680
LBN Legal business name Weaver, Mark Shannon
Credentials MS, LPC
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 14th, 2006
Last updated Dec 2nd, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1508928680 NPPES
North Carolina Other 142CE BCBS
North Carolina MEDICAID 6102622 BCBS

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