Individual
TIA D SHAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHP
Contact information
Practice address
24 SWEDEN ST, SUITE 201, CARIBOU, ME 04736-2127
(207) 493-3366
(207) 492-4889
Mailing address
24 SWEDEN ST, SUITE 201, CARIBOU, ME 04736-2127
(207) 493-3366
(207) 492-4889
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346674124
—
ME
Enumeration date
08/28/2013
Last updated
08/20/2014
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