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1124363718
SHASTA GABRIELLE STATEN
CHARLOTTE, NC
NPI
1124363718
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
101YP2500X Counselor, Professional
(Licence: NC 9182)
Enumeration Date
2012-12-07
Last Update Date
2021-06-23
Business Address
SHASTA GABRIELLE STATEN Med, LPC
5200 PARK RD STE 218B
CHARLOTTE, NC 28209-3650
Phone number: 866-700-1606
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Mailing Address
SHASTA GABRIELLE STATEN Med, LPC
12664 PERSIMMON TREE DR
CHARLOTTE, NC 28273-8024
Phone number: 704-621-1095
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