Provider Demographics
NPI:1861439945
Name:SHAW, LIZA MERRILL (MA, LMFT, ACHT)
Entity Type:Individual
Prefix:MS
First Name:LIZA
Middle Name:MERRILL
Last Name:SHAW
Suffix:
Gender:F
Credentials:MA, LMFT, ACHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 2ND ST NE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3869
Mailing Address - Country:US
Mailing Address - Phone:828-302-2978
Mailing Address - Fax:828-328-4673
Practice Address - Street 1:926 2ND ST NE
Practice Address - Street 2:SUITE 103
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3869
Practice Address - Country:US
Practice Address - Phone:828-302-2978
Practice Address - Fax:828-328-4673
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC136ENOtherBCBS PROVIDER ID