| NPI | 1619495025 |
|---|---|
| Former Name | CLAIR THERESE SHACKELFORD |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: ID LCSW-42909) |
| Additional Taxonomies | 104100000X Social Worker (Licence: ID 36837) |
| Enumeration Date | 2017-09-06 |
| Last Update Date | 2023-05-19 |