Provider Demographics
NPI:1427378819
Name:SHAFFER, KIM MARIE (LCPC)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:KIM
Other - Middle Name:MARIE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:43 ACME RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:BREWER
Mailing Address - State:ME
Mailing Address - Zip Code:04412-1544
Mailing Address - Country:US
Mailing Address - Phone:207-991-5818
Mailing Address - Fax:
Practice Address - Street 1:43 ACME RD
Practice Address - Street 2:SUITE H
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1544
Practice Address - Country:US
Practice Address - Phone:207-991-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-08
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3651101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health