Provider Demographics
NPI:1780935122
Name:SHAFFER, LINDA L (MA, EDS, LCAS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:L
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:MA, EDS, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 S LAFAYETTE ST APT 11
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-5485
Mailing Address - Country:US
Mailing Address - Phone:704-482-2460
Mailing Address - Fax:704-487-5950
Practice Address - Street 1:824 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6182
Practice Address - Country:US
Practice Address - Phone:704-482-2460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2155101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2155OtherNC LICENSE