Provider Demographics
NPI:1750877254
Name:RALLINS, SHONITTA LATRICE
Entity type:Individual
Prefix:MRS
First Name:SHONITTA
Middle Name:LATRICE
Last Name:RALLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 SIMS AVE
Mailing Address - Street 2:
Mailing Address - City:GRAMBLING
Mailing Address - State:LA
Mailing Address - Zip Code:71245-3307
Mailing Address - Country:US
Mailing Address - Phone:318-243-9099
Mailing Address - Fax:
Practice Address - Street 1:265 SIMS AVE
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-3307
Practice Address - Country:US
Practice Address - Phone:318-243-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-08
Last Update Date:2018-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator