Provider Demographics
NPI:1942804265
Name:SHOEMAKER, ADRIANNA MEIRA (MAT, BCBA)
Entity Type:Individual
Prefix:
First Name:ADRIANNA
Middle Name:MEIRA
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MAT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 GREENE ST # 5495
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29205-1641
Mailing Address - Country:US
Mailing Address - Phone:803-727-8647
Mailing Address - Fax:
Practice Address - Street 1:2108 GREENE ST # 5495
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29205-1641
Practice Address - Country:US
Practice Address - Phone:803-727-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1-20-43508103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst