Individual
ANGELA SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
635 N MAIN ST, WICHITA, KS 67203-3602
(316) 660-7600
(316) 660-7510
Mailing address
438 S GEORGIE AVE, DERBY, KS 67037-1224
(316) 789-0620
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
1494
KS
104100000X
Social Worker
Primary
8916
KS
Other
Enumeration date
01/13/2014
Last updated
01/03/2020
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