Active NPI
Jacqueline Shaw, LPC
- Professional Counselor
- Rocky Mount, NC
National Provider Identifier
1689959694
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 8086
- Practice address
- 633 Weathervane Way
Rocky Mount, NC 27803-8736 - Phone
- (252) 451-0148
- NPI assigned
- Oct 21, 2011
- Last updated
- Oct 21, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 8086 | NC | Primary |
Addresses
Primary practice location
633 Weathervane Way
Rocky Mount, NC 27803-8736
Mailing address
633 Weathervane Way
Rocky Mount, NC 27803-8736
Phone (252) 451-0148
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8086 | NC | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319155200000",
"number": "1689959694",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "633 WEATHERVANE WAY",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278038736",
"telephone_number": "252-451-0148"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "633 WEATHERVANE WAY",
"city": "ROCKY MOUNT",
"state": "NC",
"postal_code": "278038736",
"telephone_number": "252-451-0148"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "JACQUELINE",
"name_prefix": "Dr.",
"credential": "LPC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-21",
"last_updated": "2011-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "NC",
"license": "8086",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rocky Mount, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.