Provider Demographics
NPI:1669966685
Name:ALDRIDGE, SHAWN S (LICDC)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:S
Last Name:ALDRIDGE
Suffix:
Gender:M
Credentials:LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17618 STATE ROUTE 93
Mailing Address - Street 2:
Mailing Address - City:PEDRO
Mailing Address - State:OH
Mailing Address - Zip Code:45659-8754
Mailing Address - Country:US
Mailing Address - Phone:740-646-5753
Mailing Address - Fax:
Practice Address - Street 1:11826 GALLIA PIKE STE C
Practice Address - Street 2:
Practice Address - City:WHEELERSBURG
Practice Address - State:OH
Practice Address - Zip Code:45694-9119
Practice Address - Country:US
Practice Address - Phone:740-876-4117
Practice Address - Fax:800-480-7578
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-22
Last Update Date:2025-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.162867101YA0400X
OHLCDCII.161764101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0342311Medicaid