Individual
SHANICE DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12615 S MAIN ST, SOMERVILLE, TN 38068-1673
(901) 465-9831
Mailing address
1997 HIGHWAY 51 S, COVINGTON, TN 38019-3630
(901) 476-8967
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
11343
TN
Other
Enumeration date
10/06/2017
Last updated
10/06/2017
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