Provider Demographics
NPI:1124585054
Name:SHAW, RICHARD (LMFTA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:LMFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 CHARLOTTE ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28801-1970
Mailing Address - Country:US
Mailing Address - Phone:828-278-4561
Mailing Address - Fax:
Practice Address - Street 1:138 CHARLOTTE ST STE 204
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-1970
Practice Address - Country:US
Practice Address - Phone:828-278-4561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC12146A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)