Healthcare Provider Details

I. General information

NPI: 1427829118
Provider Name (Legal Business Name): SHARDENA THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 PROSPECT AVE E
CLEVELAND OH
44115-2322
US

IV. Provider business mailing address

1710 PROSPECT AVE E
CLEVELAND OH
44115-2322
US

V. Phone/Fax

Practice location:
  • Phone: 216-781-3773
  • Fax: 216-781-2023
Mailing address:
  • Phone: 216-731-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.165167
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: