Provider Demographics
NPI:1679609341
Name:SHAFFER, WANDA FAYE (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:WANDA
Middle Name:FAYE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5638 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2408
Mailing Address - Country:US
Mailing Address - Phone:706-221-9210
Mailing Address - Fax:706-221-5427
Practice Address - Street 1:5638 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2408
Practice Address - Country:US
Practice Address - Phone:706-221-9210
Practice Address - Fax:706-221-5427
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC004633101YP2500X
AL2510101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional