Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 104100000X | Social Worker | ||
N | 225XM0800X | Mental Health |
NPI | 1508433095 |
---|---|
Provider Name | Shanita Ann Mccall |
First Address | Jackson, GA 30233-5557 |
Second Address | Jackson, GA 30233-5557 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2021 |
Last Update Date | 04/06/2021 |