Individual
JACQUETTA C. DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
856 TEXAS AVE, SHREVEPORT, LA 71101-3400
(318) 429-6977
Mailing address
429 JORDAN DR APT 1212, BOSSIER CITY, LA 71112-4079
(318) 771-1542
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
5769
LA
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1265802938
—
LA
Enumeration date
10/06/2015
Last updated
12/08/2020
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