Individual
MR. TONY C SHAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LCPC
Contact information
Practice address
102 6TH AVE NE STE B, GLEN BURNIE, MD 21060-6869
(410) 352-7514
Mailing address
2814 W GARRISON AVE, BALTIMORE, MD 21215-5335
(443) 629-5155
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
LC11938
MD
101YM0800X
Mental Health Counselor
Primary
LC11938
MD
Other
Enumeration date
08/20/2020
Last updated
07/01/2022
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