Tiffany Sheree Shaw, LCMHC,LPC, NCC, LCAS

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

7366 Issued in NC

Practice address

700 24TH St
Fort Lee, VA 23801-1716

Phone

(804) 734-9623

Fax

(804) 734-9188

NPI assigned

Jun 12, 2009

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Independence Counseling and Consulting Services, PLLC

  • Mental Health Counselor
  • Raeford, NC
  • NPI 1932445996
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686182400000",
    "number": "1063649374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "946 MOCKINGBIRD HILL RD",
            "city": "RAEFORD",
            "state": "NC",
            "postal_code": "283766363",
            "telephone_number": "910-261-4635"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 24TH ST",
            "city": "FORT LEE",
            "state": "VA",
            "postal_code": "238011716",
            "telephone_number": "804-734-9623",
            "fax_number": "804-734-9188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "TIFFANY",
        "middle_name": "SHEREE",
        "credential": "LCMHC,LPC, NCC, LCAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-12",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "2075",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NC",
            "license": "7366",
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NC",
            "license": "7366",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Riddle Scarff, M.D.
• Kimberly Schoen, RN
• John Joseph Seckora Jr., RPH
• Dawn Sellers, PMHNP
• Deborah L. Sessums, L.P.N.
• Eduardo D Sinaguinan, MD
• Katharyn Slaybaugh, LCSW
• Cherie Rochelle Smith, PA
• Estela Torres Smith, MD
• Frances Hoberta Sommerville, LPN/CCT

• Professional Counselor in Fort Lee, VA
• Providers in Fort Lee, VA by specialty
• Professional Counselor in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.