Provider Demographics
NPI:1043901069
Name:VANDORN, SHANNON BERNICE (CADC)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:BERNICE
Last Name:VANDORN
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1076 ROUTE 47 S
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE
Mailing Address - State:NJ
Mailing Address - Zip Code:08242-1608
Mailing Address - Country:US
Mailing Address - Phone:609-741-6363
Mailing Address - Fax:
Practice Address - Street 1:18 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:CAPE MAY COURT HOUSE
Practice Address - State:NJ
Practice Address - Zip Code:08210-2024
Practice Address - Country:US
Practice Address - Phone:609-305-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37CA00182200101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)