Healthcare Provider Details

I. General information

NPI: 1437632759
Provider Name (Legal Business Name): SHANE MICHAEL SATTERFIELD MSW, LSW, LICDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 02/05/2023
Certification Date: 02/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3153 SOVEREIGN DR
CINCINNATI OH
45251-3160
US

IV. Provider business mailing address

3153 SOVEREIGN DR
CINCINNATI OH
45251-3160
US

V. Phone/Fax

Practice location:
  • Phone: 513-410-8142
  • Fax: 513-407-6918
Mailing address:
  • Phone: 513-410-8142
  • Fax: 513-407-6918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberLICDC.162128
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberS.1700057
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: