Provider Demographics
NPI:1033437058
Name:SHAFFER, VICTORIA (LCPC)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9307 HEATHER FIELD CT
Mailing Address - Street 2:
Mailing Address - City:LAYTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20882-3722
Mailing Address - Country:US
Mailing Address - Phone:240-401-2454
Mailing Address - Fax:
Practice Address - Street 1:933 RUSSELL AVE
Practice Address - Street 2:SUITE D
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3290
Practice Address - Country:US
Practice Address - Phone:240-401-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC1939101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional