Individual
TANEKA M FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1406 HAWN AVE, SHREVEPORT, LA 71107-6532
(318) 675-0224
(318) 675-0226
Mailing address
PO BOX 78776, SHREVEPORT, LA 71137-8776
(318) 675-0224
(318) 675-0226
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4867
LA
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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