Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 1211148 | OH |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 8291 | PA |
NPI | 1003354804 |
---|---|
Provider Name | Shawn Halverstadt |
First Address | Columbiana, OH 44408-8407 |
Second Address | Columbiana, OH 44408-8407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2017 |
Last Update Date | 02/02/2017 |