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General NPI Number Information
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NPI Number | 1821448390
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Entity Type | Individual
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Provider Name | SHALONDA NAKIA ADAMS-YOUNG PEER SPECIALIST
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Gender | Male
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 135 N CLEVELAND ST
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City | MEMPHIS
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State | TN
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Zip | 38104-2002
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Country | US
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Telephone | 800-274-1843
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Fax |
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Provider Business Mailing Address
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Address Line | 905 SPRINGDALE RUN DR
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City | MEMPHIS
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State | TN
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Zip | 38108-3342
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Country | US
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Telephone | 901-314-0856
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Fax | 901-805-9400
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TR0400X
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Taxonomy Name | Rehabilitation Psychologist
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License Number | L000000017975
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 000-1180
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License Number State | TN
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