Individual
MARY JOHNETT WATERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
820 JORDAN ST, SUITE 220, SHREVEPORT, LA 71101-4519
(318) 226-8753
(318) 226-8754
Mailing address
820 JORDAN ST, SUITE 220, SHREVEPORT, LA 71101-4519
(318) 226-8753
(318) 226-8754
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2689
LA
Other
Enumeration date
08/29/2006
Last updated
07/08/2007
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