Individual
SHELBY LANE CISSOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2441B COUNTY ROAD 501, RIPLEY, MS 38663-9677
(662) 837-4258
Mailing address
PO BOX 839, CORINTH, MS 38835-0839
(662) 286-9883
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
10/04/2022
Last updated
10/04/2022
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