Provider Demographics
NPI:1659895324
Name:THURMOND, SHAWNDA ELLAINE (LSW)
Entity Type:Individual
Prefix:
First Name:SHAWNDA
Middle Name:ELLAINE
Last Name:THURMOND
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SHAWNDA
Other - Middle Name:ELLAIN
Other - Last Name:HICKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8003 TRIBUTARY LN
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9434
Mailing Address - Country:US
Mailing Address - Phone:614-592-9317
Mailing Address - Fax:
Practice Address - Street 1:1791 ALUM CREEK DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1708
Practice Address - Country:US
Practice Address - Phone:614-445-8131
Practice Address - Fax:614-545-0232
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-03
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1700687104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker