Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Randall Kenneth Shively, PHD, LICDC

Individual provider Addiction (Substance Use Disorder) Counselor · NPI 1235608084

Randall Kenneth Shively, PHD, LICDC is an Addiction (Substance Use Disorder) Counselor in Columbus, Ohio. Practices as a sole proprietor. Licensed in Ohio.

Licensed in
OH
In the registry since
2018
Specialties on file
2
What do these letters mean?
PHD — Doctor of Philosophy
A research doctorate. In healthcare it usually sits alongside a clinical licence.

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Practice location Address checks out

2100 Stella Ct
Columbus, OH 43215-1011
Phone: (614) 252-8402
Fax: (614) 252-5326
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Intellectual & Developmental Disabilities Psychologist (primary) Taxonomy 103TM1800X · Licence 4374 (OH)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 975850 (OH)

Record details

NPI number1235608084
Entity typeIndividual (Type 1)
GenderMale
Credentials PHD , LICDC
Sole proprietorYes
NPI enumeratedNovember 21, 2018
Last updated in NPPESApril 25, 2023
Certification dateApril 25, 2023

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