Provider Demographics
NPI:1306040563
Name:SHIELDS, JOHN J (CADC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:SHIELDS
Suffix:
Gender:M
Credentials:CADC
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 79
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89440-0079
Mailing Address - Country:US
Mailing Address - Phone:775-847-7131
Mailing Address - Fax:
Practice Address - Street 1:704 MILL ST.
Practice Address - Street 2:
Practice Address - City:LOYALTON
Practice Address - State:CA
Practice Address - Zip Code:96118-0265
Practice Address - Country:US
Practice Address - Phone:530-993-6714
Practice Address - Fax:530-993-6759
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2009-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV526I101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)