Provider Demographics
NPI:1578869574
Name:SHAW, RAYMOND (CSAC SAP)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:
Last Name:SHAW
Suffix:
Gender:M
Credentials:CSAC SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 3RD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-1808
Mailing Address - Country:US
Mailing Address - Phone:252-413-0401
Mailing Address - Fax:
Practice Address - Street 1:200 W 3RD ST
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-1808
Practice Address - Country:US
Practice Address - Phone:252-413-0401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCMHL-074-228171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator