Individual
DONNA SUE SMALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.L.M.H.P.
Contact information
Practice address
1410 S GRAND ST, MONROE, LA 71202-2012
(402) 324-5441
(402) 324-5442
Mailing address
2525 YOUREE DR STE 110, SHREVEPORT, LA 71104-3600
(318) 742-3408
(402) 826-5859
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
470774254-26
—
NE
01
—
94080
BLUECROSS BLUESHIELD
NE
Enumeration date
08/29/2006
Last updated
01/20/2016
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