Provider Demographics
NPI:1407123573
Name:SHAW BUCHANAN, SHERRON NICOLE (LPC, CSAC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRON
Middle Name:NICOLE
Last Name:SHAW BUCHANAN
Suffix:
Gender:F
Credentials:LPC, CSAC
Other - Prefix:
Other - First Name:SHERRON
Other - Middle Name:N
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, CSAC
Mailing Address - Street 1:7900 FORTRESS PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-6958
Mailing Address - Country:US
Mailing Address - Phone:804-690-1879
Mailing Address - Fax:
Practice Address - Street 1:7900 FORTRESS PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-6958
Practice Address - Country:US
Practice Address - Phone:804-690-1879
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-17
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701005005101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health