Organization
CARITA R SHAWCHUCK, PHD, PC
Active
Other names
Child and Family Therapy Associates
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CARITA R SHAWCHUCK PH.D. (OWNER)
(701) 893-3419
Entity
Organization
Contact information
Practice address
1121 WESTRAC DR S STE 204, FARGO, ND 58103-2385
(701) 893-3419
(701) 356-8801
Mailing address
1121 WESTRAC DR S STE 204, FARGO, ND 58103-2385
(701) 893-3419
(701) 356-8801
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
295
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
11062
—
ND
Enumeration date
10/12/2012
Last updated
10/12/2012
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