Provider Demographics
NPI:1821806712
Name:AHDERS, LEEANN SHOTTS
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:SHOTTS
Last Name:AHDERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEEANN
Other - Middle Name:SHOTTS
Other - Last Name:HOFFNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:268 MARABOU CIR
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-4737
Mailing Address - Country:US
Mailing Address - Phone:803-457-3872
Mailing Address - Fax:
Practice Address - Street 1:268 MARABOU CIR
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-4737
Practice Address - Country:US
Practice Address - Phone:803-457-3872
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11350104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker