Doctor Name: | MRS. KANDI DENISE SHAW |
NPI Number: | 1154553295 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 63352 |
Business Practice Address: | 2009 Bowie Dr Corsicana, TX - 751101515 |
Business Phone Number: | 9038723733 |
Business Fax Number: | |
Mailing Address: | 2009 Bowie Dr, CORSICANA |
State: | TX |
Postal Code: | 751101515 |
Phone Number: | 8177068757 |
Fax Number: | 9729238960 |
NPI Enumeration Date: | 08/21/2009 |
NPI Last Update Date: | 08/21/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 63352 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TX |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |