Provider Demographics
NPI:1649654260
Name:GALLOWAY, SADIGOH (LICDC-CS)
Entity type:Individual
Prefix:
First Name:SADIGOH
Middle Name:
Last Name:GALLOWAY
Suffix:
Gender:F
Credentials:LICDC-CS
Other - Prefix:
Other - First Name:SADIGOH
Other - Middle Name:
Other - Last Name:GALLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICDC-CS LSW
Mailing Address - Street 1:23811 CHAGRIN BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5525
Mailing Address - Country:US
Mailing Address - Phone:216-483-1001
Mailing Address - Fax:
Practice Address - Street 1:23811 CHAGRIN BLVD STE 105
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5525
Practice Address - Country:US
Practice Address - Phone:216-483-1001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH161688101YA0400X
OHS.1501036104100000X
OHLICDC.161688101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0477109Medicaid
OH1740936509.OtherORGANIZATION NPI
OH1649654260OtherPROVIDER NPI
1841930971.OtherALTERNATE ORG NPI
OH0262397Medicaid