Provider Demographics
NPI:1629339635
Name:SHAWWA, FEDA (LPC)
Entity Type:Individual
Prefix:
First Name:FEDA
Middle Name:
Last Name:SHAWWA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DEMOCRACY DR
Mailing Address - Street 2:SUITE 185
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3687
Mailing Address - Country:US
Mailing Address - Phone:214-868-2220
Mailing Address - Fax:
Practice Address - Street 1:5601 DEMOCRACY DR
Practice Address - Street 2:SUITE 185
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3687
Practice Address - Country:US
Practice Address - Phone:214-868-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YM0800X, 106H00000X
TX65504101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist