Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | MSW005301 | GA |
NPI | 1003203043 |
---|---|
Provider Name | Shayla Hendricks |
First Address | Snellville, GA 30078-6859 |
Second Address | Snellville, GA 30078-6859 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 16/04/2015 |