Provider Demographics
NPI:1659581114
Name:SHAIA, MARY LORETTA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LORETTA
Last Name:SHAIA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 CLOISTER CT
Mailing Address - Street 2:SUITE E
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27514-2207
Mailing Address - Country:US
Mailing Address - Phone:919-408-3212
Mailing Address - Fax:919-408-3306
Practice Address - Street 1:101 CLOISTER CT
Practice Address - Street 2:SUITE E
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2207
Practice Address - Country:US
Practice Address - Phone:919-408-3212
Practice Address - Fax:919-408-3306
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0005021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical