Provider Demographics
NPI:1629214846
Name:SHAW, TOMEKA DAVIS (LPC, NCC)
Entity Type:Individual
Prefix:MRS
First Name:TOMEKA
Middle Name:DAVIS
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 WAGONER DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-4680
Mailing Address - Country:US
Mailing Address - Phone:910-864-0179
Mailing Address - Fax:910-864-3162
Practice Address - Street 1:346 WAGONER DR
Practice Address - Street 2:SUITE 106
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-4680
Practice Address - Country:US
Practice Address - Phone:910-864-0179
Practice Address - Fax:910-864-3162
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7255101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7255OtherNORTH CAROLINA BOARD OF LICENSED PROFESSIONAL COUNSELORS