Individual
ALBERT FULLWOOD SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6015 HEARNE AVE, SHREVEPORT, LA 71108-3803
(318) 213-0904
Mailing address
1717 MARSHALL ST, SHREVEPORT, LA 71101-4139
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
600720427
LA
104100000X
Social Worker
Primary
16059
LA
171M00000X
Case Manager/Care Coordinator
16059
LA
Other
Enumeration date
08/17/2016
Last updated
08/13/2024
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