Individual
SHANNA MOORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-3145
Mailing address
969 LAKELAND DR, JACKSON, MS 39216-4606
(601) 200-3145
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
C5737
MS
Other
Enumeration date
04/05/2016
Last updated
04/05/2016
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