MEDICARE: WANDA SHAFFER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC004633	GA

General Provider Information

NPI Number	:	1730428343
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WANDA SHAFFER, LLC

Provider Business Mailing Address
First Line	:	5638 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2408
Country	:	US
Telephone Number	:	706-575-2221
Fax Number	:

Provider Business Practice Location Address
First Line	:	5638 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2408
Country	:	US
Telephone Number	:	706-575-2221
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. WANDA F SHAFFER
Credential	:	LPC
Telephone Number	:	706-575-2221

Provider Enumeration Date	:	02/04/2013
Last Update Date	:	02/04/2013

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