Provider Demographics
NPI:1962728899
Name:SCHAEFER, WAYNE GERALD
Entity type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:GERALD
Last Name:SCHAEFER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1477 EBENEZER RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732
Mailing Address - Country:US
Mailing Address - Phone:803-328-1234
Mailing Address - Fax:269-979-7766
Practice Address - Street 1:1477 EBENEZER RD
Practice Address - Street 2:SUITE B
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732
Practice Address - Country:US
Practice Address - Phone:803-328-1234
Practice Address - Fax:269-979-7766
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-16
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006337101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301006337OtherLICENSE #