| Doctor Name: | DR. KESI SHAW |
| NPI Number: | 1265803571 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ICADC-II, LPC |
| License Number: | |
| Business Practice Address: | 420 Lancaster Loop Hinesville, GA - 313138311 |
| Business Phone Number: | 7814377429 |
| Business Fax Number: | |
| Mailing Address: | 420 Lancaster Loop, HINESVILLE |
| State: | GA |
| Postal Code: | 313138311 |
| Phone Number: | 7814377429 |
| Fax Number: | |
| NPI Enumeration Date: | 10/13/2015 |
| NPI Last Update Date: | 10/13/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | GA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |