Provider Demographics
NPI:1417594151
Name:SHAW, DIANA RACHEL (EDS, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:RACHEL
Last Name:SHAW
Suffix:
Gender:F
Credentials:EDS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 WEKIVA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3607
Mailing Address - Country:US
Mailing Address - Phone:407-708-9012
Mailing Address - Fax:
Practice Address - Street 1:357 WEKIVA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-3607
Practice Address - Country:US
Practice Address - Phone:407-708-9012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH18242101YM0800X, 101YS0200X, 101YP2500X, 390200000X
FLMH20309101YP2500X, 101YS0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program