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General NPI Number Information
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NPI Number | 1003620931
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Entity Type | Individual
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Provider Name | SHASHELIA DREWNETTE KING
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Gender | Female
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Dates
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Enumeration Date | 02/03/2025
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 385 NAIL ROAD N166
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City | SOUTHAVEN
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State | MS
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Zip | 38671
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Country | US
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Telephone | 901-206-7328
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Fax |
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Provider Business Mailing Address
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Address Line | 6047 MINGLE DR
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City | MEMPHIS
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State | TN
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Zip | 38115-6234
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Country | US
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Telephone | 901-206-7328
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | M10636
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License Number State | MS
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