Most Relevant Information
Provider Data
| NPI Number: | 1003346024 |
| Provider Name: | SHALONDA ELANE WILLIS |
| Entity Type: | Individual |
| Taxonomy Code: | 104100000X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/13/2017 |
| Last Updated: | 06/13/2017 |
Provider Practice Location
122 DESOTO AVE STE 109
CLARKSDALE
MS
386144440
Practice Location Phone/Fax
| Phone: | 6625925397 |
| Fax: |
Provider Mailing Location
2525 YOUREE DR STE 110
SHREVEPORT
LA
711043600
Provider Mailing Phone/Fax
| Phone: | 3187423408 |
| Fax: |