SHANTAYIA NEAL PROVOST

DOUGLASVILLE, GA
NPI1689350084
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy1041C0700X Social Worker Clinical
(Licence: UT  184759-3102)
Enumeration Date2023-06-22
Last Update Date2023-06-22
Business Address
MRS. SHANTAYIA NEAL PROVOST LCSW
4595 FLAT WILLOW PL
DOUGLASVILLE, GA 30135-8646
Phone number: 404-548-5761
Mailing Address
MRS. SHANTAYIA NEAL PROVOST LCSW
4595 FLAT WILLOW PL
DOUGLASVILLE, GA 30135-8646
Phone number: 404-578-5761
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