Provider Demographics
NPI:1558425603
Name:SHAW, ANDREA R (PHD, MFT)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:R
Last Name:SHAW
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 HUNTERS RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-9017
Mailing Address - Country:US
Mailing Address - Phone:919-933-2311
Mailing Address - Fax:919-933-2311
Practice Address - Street 1:119 HUNTERS RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27517-9017
Practice Address - Country:US
Practice Address - Phone:919-933-2311
Practice Address - Fax:919-933-2311
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC684106H00000X
CAMK01793106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist