Organization
SUPPORTING HEALTH SERVICES SOLUTION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES MAXIE JR. MA, QMHP-CS, (OWNER)
(318) 573-3942
Entity
Organization
Contact information
Practice address
1900 S WASHINGTON AVE, MARSHALL, TX 75670-6843
(346) 290-5508
Mailing address
1840 LOGAN ST, SHREVEPORT, LA 71101-2316
(318) 573-3942
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
TX
251B00000X
Case Management Agency
—
TX
251S00000X
Community/Behavioral Health Agency
Primary
—
TX
Other
Enumeration date
04/24/2018
Last updated
05/31/2022
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