Provider Demographics
NPI:1952859688
Name:SHAW, CAROLYN RENEE (LPCA)
Entity Type:Individual
Prefix:MISS
First Name:CAROLYN
Middle Name:RENEE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 REYNOLDS AVE
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-4668
Mailing Address - Country:US
Mailing Address - Phone:919-599-5513
Mailing Address - Fax:919-419-9885
Practice Address - Street 1:308 REYNOLDS AVE
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-4668
Practice Address - Country:US
Practice Address - Phone:919-599-5513
Practice Address - Fax:919-419-9885
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA11008101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health