Provider Demographics
NPI:1689400160
Name:SHAW, TAMAIRA (LGPC)
Entity type:Individual
Prefix:
First Name:TAMAIRA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:LGPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 ISHERWOOD ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-5513
Mailing Address - Country:US
Mailing Address - Phone:202-957-4729
Mailing Address - Fax:
Practice Address - Street 1:3520 SILVER PARK DR APT 3
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2920
Practice Address - Country:US
Practice Address - Phone:202-957-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP9029101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional