SHASTA GABRIELLE STATEN MED, LPC
NPI 1124363718
Counselor - Professional in Charlotte, NC

Q: What is Shasta Staten's NPI number?

The NPI number for Shasta Staten is 1124363718. It was assigned to this individual provider in the NPPES registry on December 7, 2012.

Q: What is Shasta Staten's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

Q: When was this NPI record last updated?

The NPPES record for Shasta Staten was last updated on June 23, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since December 07, 2012

5200 PARK RD STE 218B, CHARLOTTE, NC 28209(866) 700-1606 Get Directions Write a Review

NPPES record last updated: June 23, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 23, 2021, Feb 3, 2020, Nov 5, 2018 (3 updates tracked since 2018).

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About Shasta Gabrielle Staten Med, Lpc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SHASTA GABRIELLE STATEN MED, LPC (NPI 1124363718) is an individual professional provider in Charlotte, North Carolina, licensed in North Carolina (9182) and active in the NPI registry since December 2012. She maintains a secondary practice location in Charlotte.

NPPES Registry Identity

NPI1124363718

Entity TypeIndividualFemale

Primary Taxonomy101YP2500X

Provider Legal NameSHASTA GABRIELLE STATENCredential: MED, LPC

Location Address5200 PARK RD STE 218BCharlotte, NC 28209-3650

Mailing Address12664 Persimmon Tree DrCharlotte, NC 28273-8024 · (704) 621-1095

Phone(866) 700-1606

Sole ProprietorNo

Enumeration DateDecember 7, 2012

Last NPPES UpdateJune 23, 20213 updates tracked since enumeration

NPPES CertifiedJune 23, 2021

✔ NPI 1124363718 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers

Taxonomy Code101YP2500X

License✔ Licensed in NC · 9182

5200 PARK RD STE 218B, Charlotte, NC 28209

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Secondary Practice Location 1

Location 112664 Persimmon Tree DrCharlotte, NC 28273-8024 · Phone (704) 621-1095

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. TAMATHA S. FORTUNE LPCA, NCC, CCMC

Counselor (Professional)