Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | FL |
NPI | 1003475252 |
---|---|
Provider Name | Shauntavia Clinton |
First Address | Tallahassee, FL 32301-2862 |
Second Address | Tallahassee, FL 32308-5433 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2019 |
Last Update Date | 11/06/2019 |