Healthcare Provider Details

I. General information

NPI: 1124865522
Provider Name (Legal Business Name): SHAW FAOLAN RAMEY-WRIGHT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2024
Last Update Date: 02/19/2026
Certification Date: 02/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

IV. Provider business mailing address

415 KNOLLCREST DR STE 101
REDDING CA
96002-0181
US

V. Phone/Fax

Practice location:
  • Phone: 530-392-4399
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number156330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: