Provider Demographics
NPI:1962894428
Name:SHAFFER, GEORGE (LMFT)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:SHAFFER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 RAEFORD RD
Mailing Address - Street 2:STE B
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28305-5091
Mailing Address - Country:US
Mailing Address - Phone:910-303-2982
Mailing Address - Fax:
Practice Address - Street 1:2525 RAEFORD RD
Practice Address - Street 2:STE B
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5091
Practice Address - Country:US
Practice Address - Phone:910-303-2982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-20
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1631106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist