SHANNA BOULDEN (NPI# 1306216692) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306216692 |
| Entity Type | Individual |
| Full Name | SHANNA BOULDEN |
| Practice Address |
1401 W 4th St Antioch CA 94509-1024 |
| Practice Telephone | 9257783750 |
| Practice Fax Number | 9257787412 |
| Mailing Telephone | 9257783750 |
| Mailing Fax Number | 9257787412 |
| Enumeration Date | 2015-09-30 |
| Last Update Date | 2015-09-30 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers |
| Street Address |
1401 W 4TH ST |
| City | ANTIOCH |
| State | CA |
| Zip Code | 94509-1024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912363649 | Jennifer Hernandez | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2016-01-11 |
| 1497130041 | Tiffany Heneby | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2015-07-24 |
| 1154706711 | Michelle Amaral | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2015-07-24 |
| 1295124972 | Lisa Maire Michel | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2015-01-17 |
| 1558774323 | Adam Morris | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2014-06-09 |
| 1649696220 | Shirley Jean Struasbaugh | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2014-03-06 |
| 1114289006 | Anthony Ruben Arasa | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2012-06-15 |
| 1366745473 | Edward William Tadros | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2010-12-10 |
| 1952603953 | Rebecca Noel Sanders | Counselor | 1401 W 4th St, Antioch, CA 94509-1024 | 2010-11-23 |
| 1578892360 | Anka Bhi Inc | Community/Behavioral Health | 1401 W 4th St, Antioch, CA 94509-1024 | 2009-12-08 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932733243 | A Step Above, LLC | Clinic/Center | 3648 Delta Fair Blvd., Antioch, CA 94509 | 2020-02-25 |
| 1134751167 | Dr. Jeffrey A Saladin, Dental Corporation | Dentist | 3600 Delta Fair Blvd, Antioch, CA 94509 | 2020-02-07 |
| 1962040865 | Melay Goitom | Behavioral Analyst | 3104 Delta Fair Boulevard, Antioch, CA 94509 | 2019-12-11 |
| 1518525062 | James Joseph Cook | Counselor | 624 W. 14th Street B, Antioch, CA 94509 | 2019-05-30 |
| 1922576438 | Wazma Matiee | Behavioral Analyst | 2009 Asilomar Dr., Antioch, CA 94509 | 2018-11-02 |
| 1346722360 | Dharma Rachelle Yancy | Behavioral Analyst | 3401 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1912489931 | Cristian Cruz | Behavioral Analyst | 3100-3104 Delta Fair Blvd, Antioch, CA 94509 | 2018-09-06 |
| 1780174052 | Melissa Sue Rossi | Counselor | 3701 Lone Tree Way Ste 7a, Antioch, CA 94509 | 2018-05-13 |
| 1033638085 | Elizabeth Marie Artola | Counselor | 1915 D Street, Antioch, CA 94509 | 2017-09-11 |
| 1144748690 | Andrea Michelle Newberry | Counselor | 55 E.18th St, Antioch, CA 94509 | 2017-09-05 |
| Find all providers in zip 94509 | ||||
| Taxonomy Code | 101YA0400X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Addiction (Substance Use Disorder) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861646036 | Zahra Rooshen | Counselor | 5506 Dawnview Way, Antioch, CA 94531-8616 | 2008-11-13 |
| 1023213311 | Sue G Mankini | Counselor | 2828 Filbert St, Antioch, CA 94509-7336 | 2007-06-18 |
| 1689875510 | Erion L Moore I | Counselor | 1728 Sanger Peak Way, Antioch, CA 94531-9127 | 2007-05-29 |
| 1811101843 | Agueda Philbin | Counselor | 300 L St, Antioch, CA 94509-1159 | 2007-05-09 |
| 1962624734 | Lendsey Wayne Busby | Counselor | 1915 D St, Antioch, CA 94509-2571 | 2007-05-02 |
| 1801924576 | Felisa D Gaffney | Counselor | 3700 Delta Fair Blvd Ste 210, Antioch, CA 94509 | 2007-03-02 |
| 1780725655 | Mary Powell | Counselor | 3707 Sunset Lane, Antioch, CA 94509-6101 | 2007-02-12 |
| 1992318869 | Skyler Sanderson | Counselor | 1915 D St, Antioch, CA 94509-2571 | 2020-08-28 |
| 1861001216 | Toby Martin Disney | Counselor | 1408 A St, Antioch, CA 94509-2331 | 2020-07-30 |
| 1598390973 | Brittney Leigh Smith | Counselor | 3707 Sunset Ln, Antioch, CA 94509-6101 | 2020-03-06 |
| Find all providers in ANTIOCH | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.