| NPI | 1619902160 |
|---|---|
| Former Name | GWEN E SHAW |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: TX 00989) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: TX 002503) |
| 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: TX 4952) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2009-05-06 |