Provider Demographics
NPI:1548798937
Name:SCHAEFFER, MARY TRULL (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TRULL
Last Name:SCHAEFFER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 SHIPYARD BLVD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28412-6431
Mailing Address - Country:US
Mailing Address - Phone:910-977-5410
Mailing Address - Fax:
Practice Address - Street 1:309 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:BURGAW
Practice Address - State:NC
Practice Address - Zip Code:28425-3280
Practice Address - Country:US
Practice Address - Phone:910-259-0668
Practice Address - Fax:910-202-9966
Is Sole Proprietor?:No
Enumeration Date:2017-05-30
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23740101YA0400X
NCC0122981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)