Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 5591 | NC |
N | 101YM0800X | Mental Health Counselor | 5591 | NC |
Y | 101YP2500X | Professional Counselor | 5591 | NC |
NPI | 1003031253 |
---|---|
Provider Name | Mrs. Makeba Sharice Shaw |
First Address | Wilmington, NC 28405-3855 |
Second Address | Wilmington, NC 28405-3855 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/04/2007 |
Last Update Date | 14/12/2009 |