Provider Demographics
NPI:1467916973
Name:FRANCISCO, SHANDA LAREE (CADC II)
Entity Type:Individual
Prefix:
First Name:SHANDA
Middle Name:LAREE
Last Name:FRANCISCO
Suffix:
Gender:F
Credentials:CADC II
Other - Prefix:
Other - First Name:SHANDA
Other - Middle Name:LAREE
Other - Last Name:WAUNEKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 N PAIUTE DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-6181
Mailing Address - Country:US
Mailing Address - Phone:435-586-1112
Mailing Address - Fax:435-238-4262
Practice Address - Street 1:440 N PAIUTE DR
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-6181
Practice Address - Country:US
Practice Address - Phone:435-586-1112
Practice Address - Fax:435-238-4262
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ655101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)