Provider Demographics
NPI:1033689492
Name:MENDENHALL, ADREANNA SHONELLE
Entity Type:Individual
Prefix:
First Name:ADREANNA
Middle Name:SHONELLE
Last Name:MENDENHALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7950 MARKET ST APT 2
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5934
Mailing Address - Country:US
Mailing Address - Phone:330-965-9999
Mailing Address - Fax:
Practice Address - Street 1:8440 MARKET ST
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-6703
Practice Address - Country:US
Practice Address - Phone:330-965-9999
Practice Address - Fax:330-757-0000
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-28
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS14401581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPENDINGMedicaid