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General NPI Number Information
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NPI Number | 1417668104
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Entity Type | Organization
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Legal Business Name | SHAW PSYCHOTHERAPY AND CONSULTING SERVICES LLC
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Dates
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Enumeration Date | 12/13/2022
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Last Update Date | 12/13/2022
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Provider Practice Location Address
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Address Line | 5537 GARDEN GROVE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-7471
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Country | US
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Telephone | 804-586-7765
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Fax |
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Provider Business Mailing Address
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Address Line | 5537 GARDEN GROVE RD
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City | CHESTERFIELD
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State | VA
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Zip | 23832-7471
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Country | US
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Telephone | 804-586-7765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ALNIQUE DELOATCH
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Credential | LPC
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Telephone | 804-586-7765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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