Individual
MR. EDWIN D MIRADOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RAC
Contact information
Practice address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 863-7441
Mailing address
510 E STONER AVE, SHREVEPORT, LA 71101-4243
(318) 863-7441
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1184
LA
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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