Provider Demographics
NPI:1578161840
Name:GANDY, SHONTA L (CADC)
Entity Type:Individual
Prefix:
First Name:SHONTA
Middle Name:L
Last Name:GANDY
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5751 FOX CHASE DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27105-3085
Mailing Address - Country:US
Mailing Address - Phone:336-862-3768
Mailing Address - Fax:
Practice Address - Street 1:3580 NC HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-8746
Practice Address - Country:US
Practice Address - Phone:336-522-5095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)