Individual
SHANTASHIA NIKIJAH RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3484 LACHLAN DR, SNELLVILLE, GA 30078-6001
(678) 939-7839
Mailing address
1997 KIMBERLY VILLAGE LN SE APT F, MARIETTA, GA 30067-1603
(678) 939-7839
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Enumeration date
08/25/2021
Last updated
08/25/2021
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