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Individual

MRS. MARY JUANITA SHAKES

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LCSW

Contact information

Practice address
205 HERBERT STREET, DEMOPOLIS, AL 36732
(334) 341-7400
(601) 485-5215
Mailing address
P.O. BOX 1127, DEMOPOLIS, AL 36732
(334) 341-7400
(334) 287-2331

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
0113C
AL
1041C0700X
Clinical Social Worker
Primary
0113C
MS
1041C0700X
Clinical Social Worker
C7264
MS
1041C0700X
Clinical Social Worker

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00408326
MEDICARE RAILROAD
MS
Enumeration date
11/11/2006
Last updated
08/24/2011
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