Provider Demographics
NPI:1861507717
Name:SHAFFER, PAUL R (MA, LCMHC)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:R
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:MA, LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8831 CHAPEL GROVE CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-4974
Mailing Address - Country:US
Mailing Address - Phone:704-578-2725
Mailing Address - Fax:704-264-2295
Practice Address - Street 1:9820 NORTHCROSS CENTER CT
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7356
Practice Address - Country:US
Practice Address - Phone:704-578-2725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC610101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1108YOtherBLUE CROSS/BLUESHIELD