Individual
PAMELA SHANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCSS
Contact information
Practice address
1104B CEDAR ST, WAYNESBORO, MS 39367-2417
(601) 735-3350
Mailing address
PO BOX 18679, HATTIESBURG, MS 39404-8679
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
381
MS
Other
Enumeration date
08/14/2017
Last updated
08/14/2017
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