Individual
CHAQUITA SHANTA SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1689 NONCONNAH BLVD STE 100, MEMPHIS, TN 38132-2111
(901) 523-8990
Mailing address
2023 KINGS CROSS LN, CORDOVA, TN 38016-5179
(662) 346-6570
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
7626
TN
1041C0700X
Clinical Social Worker
Primary
7626
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7626
LICENSED MASTER SOCIAL WORKER
TN
Enumeration date
06/12/2007
Last updated
09/14/2021
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