Provider Demographics
NPI:1891989265
Name:SHOAFF, CHARLES DOUGLAS (LPCC)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:DOUGLAS
Last Name:SHOAFF
Suffix:
Gender:M
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 BELMONT ST
Mailing Address - Street 2:SUITE 211
Mailing Address - City:BELLAIRE
Mailing Address - State:OH
Mailing Address - Zip Code:43906-1584
Mailing Address - Country:US
Mailing Address - Phone:740-381-2577
Mailing Address - Fax:
Practice Address - Street 1:3201 BELMONT ST
Practice Address - Street 2:SUITE 211
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-1584
Practice Address - Country:US
Practice Address - Phone:740-381-2577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1507101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000570003OtherANTHEM BLUE CROSS AND BLUE SHIELD
$$$$$$$$$OtherSOCIAL SECURITY
OH$$$$$$$$$00OtherOHO BUREAU OF WORKERS' COMPENSATION