Provider Demographics
NPI:1518176072
Name:SHAFFIELD, MAUREEN (ICADC, CTS, SAM)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:SHAFFIELD
Suffix:
Gender:F
Credentials:ICADC, CTS, SAM
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:
Other - Last Name:LUCEY-SHAFFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:3920 CLUB DRIVE #313
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8885
Mailing Address - Country:US
Mailing Address - Phone:770-265-5200
Mailing Address - Fax:
Practice Address - Street 1:215 KIRKLAND RD
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-3318
Practice Address - Country:US
Practice Address - Phone:678-209-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2015-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174101YA0400X
GA005341104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)