Provider Demographics
NPI:1679798581
Name:DAUGHERTY, SHATOSHA JAWANNA (BSW)
Entity type:Individual
Prefix:
First Name:SHATOSHA
Middle Name:JAWANNA
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38126-2023
Mailing Address - Country:US
Mailing Address - Phone:901-577-9401
Mailing Address - Fax:901-577-0207
Practice Address - Street 1:427 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38126-2023
Practice Address - Country:US
Practice Address - Phone:901-577-9401
Practice Address - Fax:901-577-0207
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical