Shanna Wideman, MA, AADC

Primary specialty

Addiction (Substance Use Disorder) PsychologistTaxonomy code 103TA0400X

Practice address

397 Mid Atlantic Pkwy
Suite 3
Martinsburg, WV 25404-7468

Phone

(304) 260-6360

Fax

(304) 260-6459

NPI assigned

Apr 23, 2009

Last updated

Oct 23, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 7

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1445558400000",
    "number": "1740424506",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "397 MID ATLANTIC PKWY STE 3",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254047468",
            "telephone_number": "304-260-6360"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "397 MID ATLANTIC PKWY",
            "address_2": "SUITE 3",
            "city": "MARTINSBURG",
            "state": "WV",
            "postal_code": "254047468",
            "telephone_number": "304-260-6360",
            "fax_number": "304-260-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMAN",
        "first_name": "SHANNA",
        "name_prefix": "Mrs.",
        "credential": "MA, AADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-04-23",
        "last_updated": "2015-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0814X",
            "taxonomy_group": "",
            "desc": "Psychologist, Psychoanalysis",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TR0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristen Whitmore
• Paul Vernon Whitmore, M.D.
• Andrea D Whittington
• Anna Whittington
• Constance A Whittington, R.N.
• Austin K Wiese, RN
• Florence Wilbik, MA, LPC
• Vickey Michelle Wilcher
• Rebecca Wiles, CRNP
• Autumn Wilfong

• Addiction (Substance Use Disorder) Psychologist in Martinsburg, WV
• Providers in Martinsburg, WV by specialty
• Addiction (Substance Use Disorder) Psychologist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.