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Individual

MR. CORY IAN SHAFER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LPC

Contact information

Practice address
675 WYOMING AVE, KINGSTON, PA 18704-3831
(570) 332-2093
Mailing address
102 N WELLES AVE, KINGSTON, PA 18704-5142
(570) 905-4738

Taxonomy

Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
PC005347
PA

Other

Enumeration date
12/17/2012
Last updated
12/23/2015
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