Provider Demographics
NPI:1669825592
Name:SHAWL, VICTORIA (MA, NCC, LCMHC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHAWL
Suffix:
Gender:F
Credentials:MA, NCC, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 RAVENCLIFF RDG STE 103
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-9261
Mailing Address - Country:US
Mailing Address - Phone:304-543-7470
Mailing Address - Fax:919-908-8167
Practice Address - Street 1:110 RAVENCLIFF RDG STE 103
Practice Address - Street 2:
Practice Address - City:GARNER
Practice Address - State:NC
Practice Address - Zip Code:27529-9261
Practice Address - Country:US
Practice Address - Phone:304-543-7470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-15
Last Update Date:2021-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12325101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional