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Individual

SHANTA HARRELL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
106 HOLLOMAN AVENUE, AHOSKIE, NC 27910
(252) 642-3606
(252) 513-8230
Mailing address
1219 NORTH CATHERINE STREET, 106 HOLLOMAN AVENUE, AHOSKIE, NC 27910
(252) 642-3606
(252) 513-8230

Taxonomy

Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
FCL-046-025
NC

Other

Enumeration date
12/30/2015
Last updated
12/30/2015
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