Provider Demographics
NPI:1003110289
Name:GOLLADAY, SHIRLEY ANN (MHS, CADC)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:ANN
Last Name:GOLLADAY
Suffix:
Gender:F
Credentials:MHS, CADC
Other - Prefix:MRS
Other - First Name:SHIRLEY
Other - Middle Name:ANN
Other - Last Name:SNODDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20303 CRAWFORD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OLYMPIA FIELDS
Mailing Address - State:IL
Mailing Address - Zip Code:60461-1073
Mailing Address - Country:US
Mailing Address - Phone:708-747-9399
Mailing Address - Fax:708-747-1908
Practice Address - Street 1:20303 CRAWFORD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:OLYMPIA FIELDS
Practice Address - State:IL
Practice Address - Zip Code:60461-1073
Practice Address - Country:US
Practice Address - Phone:708-747-9399
Practice Address - Fax:708-747-1908
Is Sole Proprietor?:No
Enumeration Date:2011-01-03
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26382101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)