Individual
JACKARA SHADASHA DEWALT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 PLATT SPRINGS RD APT 34, WEST COLUMBIA, SC 29169-5542
(803) 290-0522
Mailing address
325 S CHURCH ST, SPARTANBURG, SC 29306-5231
(803) 290-0522
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/09/2022
Last updated
09/09/2022
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