Individual
REVONDER THOMAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 221-8411
(318) 424-6156
Mailing address
510 E. STONER AVE., SHREVEPORT, LA 71101-4295
(318) 221-8411
(318) 424-6156
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8942
LA
Other
Enumeration date
10/28/2008
Last updated
10/28/2008
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