Provider Demographics
NPI:1003181165
Name:SHAW, ROBIN DOUGLAS (LCP)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:DOUGLAS
Last Name:SHAW
Suffix:
Gender:M
Credentials:LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 FLOWING SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:ATKINS
Mailing Address - State:VA
Mailing Address - Zip Code:24311-3096
Mailing Address - Country:US
Mailing Address - Phone:252-521-3154
Mailing Address - Fax:
Practice Address - Street 1:1333 FLOWING SPRINGS RD
Practice Address - Street 2:
Practice Address - City:ATKINS
Practice Address - State:VA
Practice Address - Zip Code:24311-2214
Practice Address - Country:US
Practice Address - Phone:252-521-3154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-21
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical