Individual
SHANNON ANN CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1340 BROAD AVE, STE 410, GULFPORT, MS 39501-2404
(228) 867-5202
(228) 867-5007
Mailing address
11150 HIGHWAY 49, GULFPORT, MS 39503-4110
(228) 867-5202
(228) 867-5007
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
2999
LA
1041C0700X
Clinical Social Worker
Primary
C2562
MS
Other
Enumeration date
12/07/2012
Last updated
12/07/2012
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