Individual
MRS. REGINA HARTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RAC
Contact information
Practice address
416 WILDOAK DR, HAUGHTON, LA 71037-7927
(318) 364-7673
Mailing address
725 JORDAN ST, SHREVEPORT, LA 71101-4615
(318) 364-7673
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1510
LA
Other
Enumeration date
10/13/2015
Last updated
10/13/2015
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