Provider Demographics
NPI:1134008493
Name:SHAW, ADRIENNE ELAINE (LCMHCA)
Entity type:Individual
Prefix:
First Name:ADRIENNE
Middle Name:ELAINE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 WILLOWBROOK DR NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-4242
Mailing Address - Country:US
Mailing Address - Phone:704-299-6795
Mailing Address - Fax:
Practice Address - Street 1:9541 JULIAN CLARK AVE STE 110
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3485
Practice Address - Country:US
Practice Address - Phone:704-659-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-30
Last Update Date:2025-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA21699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health