Individual
CAROLYN FITZGERALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5100
Mailing address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 675-5100
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
4179
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174173
—
LA
Enumeration date
10/14/2010
Last updated
10/14/2010
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