Provider Demographics
NPI:1215587357
Name:SHAW, COREY MCCARTHY (MED, LPCA)
Entity Type:Individual
Prefix:MS
First Name:COREY
Middle Name:MCCARTHY
Last Name:SHAW
Suffix:
Gender:F
Credentials:MED, LPCA
Other - Prefix:MS
Other - First Name:COREY
Other - Middle Name:ANN
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 LONGBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-9085
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:207 LONGBRIDGE DR
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-9085
Practice Address - Country:US
Practice Address - Phone:770-634-3625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA10108101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional