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Individual

CARLA MCCORMICK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
416 PENNSYLVANIA AVE, SHREVEPORT, LA 71105-3136
(318) 218-1574
Mailing address
416 PENNSYLVANIA AVE, SHREVEPORT, LA 71105-3136
(318) 218-1574

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
08/11/2016
Last updated
08/11/2016
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