Provider Demographics
NPI:1053772673
Name:SHAW & ASSOCIATES, LLC
Entity type:Organization
Organization Name:SHAW & ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRON
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, CSAC
Authorized Official - Phone:804-690-1879
Mailing Address - Street 1:7900 FORTRESS PL
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-6958
Mailing Address - Country:US
Mailing Address - Phone:804-690-1879
Mailing Address - Fax:804-507-1782
Practice Address - Street 1:7900 FORTRESS PL
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231-6958
Practice Address - Country:US
Practice Address - Phone:804-690-1879
Practice Address - Fax:804-507-1782
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710102270101YA0400X
VA0701005005101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty