Individual
JENESIS RAQUEL GIBSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6938
Mailing address
8706 SAINT VINCENT AVE, SHREVEPORT, LA 71106-5557
(225) 931-5479
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
6454
LA
Other
Enumeration date
09/25/2017
Last updated
09/25/2017
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