Individual
SHANTELLE MYKIA HANNAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
216 WALNUT ST, RIDGELAND, MS 39157-2830
(601) 575-8182
Mailing address
216 WALNUT ST, RIDGELAND, MS 39157-2830
(601) 575-8182
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C8913
MS
Other
Enumeration date
02/08/2022
Last updated
02/08/2022
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