Individual
DWAILEN ORUPABO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1513 LINE AVE STE 315, SHREVEPORT, LA 71101
(318) 221-2828
Mailing address
189 NELDA CIRCLE STE 315, SHREVEPORT, LA 71101
(318) 221-2828
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
05/08/2017
Last updated
05/08/2017
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