Individual
DERRICK LAMAR ADDISON SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
9467 MILBANK DR, SHREVEPORT, LA 71115-3868
(318) 655-6318
Mailing address
1717 MARSHALL ST, SHREVEPORT, LA 71101-4139
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
LA
101YM0800X
Mental Health Counselor
—
—
Other
Enumeration date
07/28/2017
Last updated
07/28/2017
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