Provider Demographics
NPI:1144962507
Name:ANDREW SHAW COUNSELING AND CONSULTING, PLLC
Entity type:Organization
Organization Name:ANDREW SHAW COUNSELING AND CONSULTING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER ORGANIZER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LCMHC
Authorized Official - Phone:919-436-1817
Mailing Address - Street 1:PMB 770
Mailing Address - Street 2:4801 GLENWOOD AVE STE 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27612-3857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4030 WAKE FOREST RD STE 349
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-0010
Practice Address - Country:US
Practice Address - Phone:919-436-1817
Practice Address - Fax:919-578-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-07
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty