MEDICARE: MS. WANDA FAYE SHAFFER LPC, NCC

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	2510	AL
2	101YP2500X	Professional Counselor	LPC004633	GA

General Provider Information

NPI Number	:	1679609341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. WANDA FAYE SHAFFER LPC, NCC

Provider Business Mailing Address
First Line	:	5638 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-2408
Country	:	US
Telephone Number	:	706-221-9210
Fax Number	:	706-221-5427

Provider Business Practice Location Address
First Line	:	1661 13TH ST STE 102
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31901-3844
Country	:	US
Telephone Number	:	706-575-7361
Fax Number	:	706-873-2712

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	10/23/2024

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