Provider Demographics
NPI:1396025862
Name:SHAW, NAKIA C (EDD)
Entity Type:Individual
Prefix:
First Name:NAKIA
Middle Name:C
Last Name:SHAW
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 EL MONTE CT
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-8813
Mailing Address - Country:US
Mailing Address - Phone:770-256-1259
Mailing Address - Fax:
Practice Address - Street 1:23 EASTBROOK BEND SUITE 200
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30369-8813
Practice Address - Country:US
Practice Address - Phone:770-256-1259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-27
Last Update Date:2013-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC006194101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional