Provider Demographics
NPI:1093072258
Name:SHAW, PARAMOUNT LEE (LPC/MASTERS)
Entity Type:Individual
Prefix:MR
First Name:PARAMOUNT
Middle Name:LEE
Last Name:SHAW
Suffix:
Gender:M
Credentials:LPC/MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 HELLAMS ST
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN INN
Mailing Address - State:SC
Mailing Address - Zip Code:29644-9445
Mailing Address - Country:US
Mailing Address - Phone:864-862-7384
Mailing Address - Fax:
Practice Address - Street 1:5500 EXECUTIVE CENTER DR STE 106
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28212-8851
Practice Address - Country:US
Practice Address - Phone:864-862-7384
Practice Address - Fax:980-224-7948
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-12
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5462101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor