Provider Demographics
NPI:1730929993
Name:SHAFFER HAGMAN, SHERRY (CRC LCP)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:
Last Name:SHAFFER HAGMAN
Suffix:
Gender:F
Credentials:CRC LCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 36
Mailing Address - Street 2:
Mailing Address - City:SOUTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44470-0036
Mailing Address - Country:US
Mailing Address - Phone:330-219-8539
Mailing Address - Fax:330-889-0096
Practice Address - Street 1:PO BOX 36
Practice Address - Street 2:
Practice Address - City:SOUTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:44470-0036
Practice Address - Country:US
Practice Address - Phone:330-219-8539
Practice Address - Fax:330-889-0096
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-27
Last Update Date:2024-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.0008422101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional