Provider Demographics
NPI:1770050015
Name:SHOFFNER, THOMAS (LPC)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:SHOFFNER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 471
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-0471
Mailing Address - Country:US
Mailing Address - Phone:601-389-8284
Mailing Address - Fax:601-300-8082
Practice Address - Street 1:271 W BEACON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-3152
Practice Address - Country:US
Practice Address - Phone:601-389-8284
Practice Address - Fax:601-781-4233
Is Sole Proprietor?:No
Enumeration Date:2018-10-24
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2448101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor