Doctor Name: | DR. WELLINGTON (TONY) WILBERT SHAW |
NPI Number: | 1659608909 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD, NCP, CAPP, CART |
License Number: | CAPP-320, NCP-01277 |
Business Practice Address: | 3872 Long Branch Lane Apopka, FL - 327124790 |
Business Phone Number: | 4078808916 |
Business Fax Number: | 4078808916 |
Mailing Address: | 3872 Long Branch Ln, APOPKA |
State: | FL |
Postal Code: | 327124790 |
Phone Number: | 4078808916 |
Fax Number: | 4078808916 |
NPI Enumeration Date: | 11/06/2009 |
NPI Last Update Date: | 11/06/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | CAPP-320, NCP-01277 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |