Provider Demographics
NPI:1427331057
Name:SHAFFER, PAMELA MARIE (LPC, LCASA)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:MARIE
Last Name:SHAFFER
Suffix:
Gender:F
Credentials:LPC, LCASA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:284 EXECUTIVE PARK DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28025-1894
Mailing Address - Country:US
Mailing Address - Phone:704-939-1100
Mailing Address - Fax:704-939-1173
Practice Address - Street 1:205 MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28370
Practice Address - Country:US
Practice Address - Phone:910-295-6853
Practice Address - Fax:910-295-9183
Is Sole Proprietor?:No
Enumeration Date:2011-09-20
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC10156101YM0800X
NC2802A101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)