NPIMap

Individual provider Active NPI

Shirley Ann Golladay, MHS, CADC

  • Addiction (Substance Use Disorder) Counselor
  • Olympia Fields, IL
National Provider Identifier
1003110289
Registry record updated Jan 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
26382 Issued in IL
Practice address
20303 Crawford Ave
Suite 100
Olympia Fields, IL 60461-1073
Phone
(708) 747-9399
Fax
(708) 747-1908
NPI assigned
Jan 3, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 26382 IL Primary

Addresses

Primary practice location

20303 Crawford Ave
Suite 100
Olympia Fields, IL 60461-1073

Mailing address

20303 Crawford Ave
Suite 100
Olympia Fields, IL 60461-1073
Phone (708) 747-9399

Other names 1

  • Mrs. Shirley Ann Snoddy Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
26382ILMDAddiction (Substance Use Disorder) Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Kingdom Living Outreach Services, Inc Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1294012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294012800000",
    "number": "1003110289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "address_2": "SUITE 100",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-747-9399",
            "fax_number": "708-747-1908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20303 CRAWFORD AVE",
            "address_2": "SUITE 100",
            "city": "OLYMPIA FIELDS",
            "state": "IL",
            "postal_code": "604611073",
            "telephone_number": "708-747-9399",
            "fax_number": "708-747-1908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLLADAY",
        "first_name": "SHIRLEY",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "MHS, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-03",
        "last_updated": "2011-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "26382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SHIRLEY",
            "last_name": "SNODDY",
            "middle_name": "ANN",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Olympia Fields, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.