Individual
ANGELA SHORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
240 MCNAIR RD, FAYETTE, MS 39069-5540
(601) 786-7744
Mailing address
240 MCNAIR RD, FAYETTE, MS 39069-5540
(601) 786-7744
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7411
MS
Other
Enumeration date
03/05/2020
Last updated
03/05/2020
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