Individual
SHANNON RAQUEL SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
140 MAYFAIR RD STE 700, HATTIESBURG, MS 39402-1616
(601) 470-8108
Mailing address
2534 HIGHWAY 590 W, SEMINARY, MS 39479-8946
(601) 470-8108
(601) 879-6301
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C9329
MS
Other
Enumeration date
11/07/2021
Last updated
06/13/2022
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