Provider Demographics
NPI:1215410998
Name:ADANANDUS, SHANIQUA NICOLE (CDCA)
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:NICOLE
Last Name:ADANANDUS
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1289 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2838
Mailing Address - Country:US
Mailing Address - Phone:614-252-8834
Mailing Address - Fax:
Practice Address - Street 1:3797 E DESHLER AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43227-3339
Practice Address - Country:US
Practice Address - Phone:614-674-7641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCDCA.167939101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)