Active NPI
Angela Rose Shaver, CDCA
- Addiction (Substance Use Disorder) Counselor
- Jackson, OH
National Provider Identifier
1831770171
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 176433
- Practice address
- 14761 State Route 93 Unit 4
Jackson, OH 45640-9820 - Phone
- (740) 577-3100
- NPI assigned
- Apr 19, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 176433 | OH | Primary |
Addresses
Primary practice location
14761 State Route 93 Unit 4
Jackson, OH 45640-9820
Mailing address
14761 St RT 93 Unit 4
Jackson, OH 45640
Phone (740) 208-6923
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 176433 | Medicaid | OH |
Other names 1
- Mr. Angela Rose White
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Gallipolis | Other |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 176433 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618790400000",
"number": "1831770171",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14761 ST RT 93 UNIT 4",
"city": "JACKSON",
"state": "OH",
"postal_code": "45640",
"telephone_number": "740-208-6923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "14761 STATE ROUTE 93 UNIT 4",
"city": "JACKSON",
"state": "OH",
"postal_code": "456409820",
"telephone_number": "740-577-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAVER",
"first_name": "ANGELA",
"middle_name": "ROSE",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-19",
"last_updated": "2021-04-19",
"certification_date": "2021-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "176433",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "176433",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Gallipolis",
"affiliation": "N",
"use": "OTHER",
"useDescription": "Other",
"useOtherDescription": "jackson",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "jackson",
"address_1": "14761 State Route 93 Unit 4",
"city": "Jackson",
"state": "OH",
"country_code": "US",
"postal_code": "456409820",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "ANGELA",
"last_name": "WHITE",
"middle_name": "ROSE",
"prefix": "MR.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Jackson, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.