Provider Demographics
NPI:1598364820
Name:GADDIS, SHALONDA D (LPC, EDD)
Entity Type:Individual
Prefix:
First Name:SHALONDA
Middle Name:D
Last Name:GADDIS
Suffix:
Gender:F
Credentials:LPC, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 OLD LINCOLN HWY
Mailing Address - Street 2:
Mailing Address - City:TALLADEGA
Mailing Address - State:AL
Mailing Address - Zip Code:35160-8655
Mailing Address - Country:US
Mailing Address - Phone:256-589-1756
Mailing Address - Fax:
Practice Address - Street 1:1525 LEIGHTON AVE STE B
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-3805
Practice Address - Country:US
Practice Address - Phone:256-343-4080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional