Provider Demographics
NPI:1912294893
Name:SHAW, ANNIE LAVERNE CUMMINGS (LPC)
Entity type:Individual
Prefix:MRS
First Name:ANNIE
Middle Name:LAVERNE CUMMINGS
Last Name:SHAW
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
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Mailing Address - Street 1:104 EMERALD GLADE CT
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-3771
Mailing Address - Country:US
Mailing Address - Phone:919-720-8461
Mailing Address - Fax:
Practice Address - Street 1:3801 COMPUTER DR
Practice Address - Street 2:SUITE 112
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-6506
Practice Address - Country:US
Practice Address - Phone:919-720-8461
Practice Address - Fax:888-235-4554
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC8621101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6104857Medicaid