Individual
MRS. SHAQUITA A MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
4624 NISQUALLY RD, JACKSON, MS 39206-3342
(662) 307-0381
Mailing address
119 HAWTHORNE VALE, RIDGELAND, MS 39157-2345
(662) 307-0381
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C7864
MS
Other
Enumeration date
03/12/2019
Last updated
04/11/2021
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