Individual
CONSTANCE COLETTLE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9245 WALLACE LAKE RD STE A, SHREVEPORT, LA 71106
(318) 221-2828
Mailing address
PO BOX 349, STONEWALL, LA 71078-0349
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
172V00000X
Community Health Worker
Primary
—
—
Other
Enumeration date
10/21/2017
Last updated
05/17/2018
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