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Individual
NISSA BLAIR SHAKOCIUS
Active
Individual
NISSA BLAIR SHAKOCIUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
24656
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2872244-08
—
TX
05
—
287224402
—
TX
Enumeration date
08/12/2008
Last updated
05/12/2020
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