Organization
MIND REHABILITATION & RESOURCE CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KAMIQUE MICHELLE JOHNSON (MENTAL HEALTH PROFESSIONAL)
(318) 780-2828
Entity
Organization
Contact information
Practice address
1513 LINE AVE STE 135, SHREVEPORT, LA 71101-4621
(318) 828-1455
Mailing address
2923 OAK FOREST LN, SHREVEPORT, LA 71107-5802
(318) 780-2828
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
19320000X/101YM0800X
LA
Other
Enumeration date
02/16/2016
Last updated
02/16/2016
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