Healthcare Provider Details

I. General information

NPI: 1801248984
Provider Name (Legal Business Name): CARLA SHAFFER PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 E MAIN ST
RICHMOND VA
23219-2109
US

IV. Provider business mailing address

17 E MAIN ST
RICHMOND VA
23219-2109
US

V. Phone/Fax

Practice location:
  • Phone: 804-495-0676
  • Fax:
Mailing address:
  • Phone: 804-495-0676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005414
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number0810005414
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: