Healthcare Provider Details

I. General information

NPI: 1801973482
Provider Name (Legal Business Name): JOANNE M SCHAFFER MSW LCSW PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/29/2022
Certification Date: 01/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1618 US 1 HWY
YOUNGSVILLE NC
27596-9219
US

IV. Provider business mailing address

1618 US 1 HWY
YOUNGSVILLE NC
27596-9219
US

V. Phone/Fax

Practice location:
  • Phone: 919-562-9922
  • Fax: 919-562-9917
Mailing address:
  • Phone: 919-562-9922
  • Fax: 919-562-9917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC004022
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. JOANNE MARIE SCHAFFER
Title or Position: PRESIDENT
Credential: MSW, LCSW
Phone: 919-562-9922