Provider Demographics
NPI:1447210265
Name:SHAVER-HAST, LAURA (LISW)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:SHAVER-HAST
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1415 RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2519
Mailing Address - Country:US
Mailing Address - Phone:803-960-9547
Mailing Address - Fax:
Practice Address - Street 1:1415 RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2519
Practice Address - Country:US
Practice Address - Phone:803-960-9547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC52201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQM0391Medicaid
SCQ313490281Medicare UPIN
SCQM0391Medicaid