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 |