Individual
TYESHA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11321 WALTON LAKE RD, DISPUTANTA, VA 23842-4510
(804) 930-3280
Mailing address
11321 WALTON LAKE RD, DISPUTANTA, VA 23842-4510
(804) 930-3280
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
7094-07-006
VA
Other
Enumeration date
01/26/2023
Last updated
01/26/2023
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