Individual
MS. SHANASIA VICTRUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
177 HAYES CIR, REX, GA 30273-1543
(678) 613-3542
Mailing address
177 HAYES CIR, REX, GA 30273-1543
(678) 613-3542
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/05/2022
Last updated
08/05/2022
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