Individual
WILLIAM ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
2000 FAIRFIELD AVENUE, SHREVEPORT, LA 71104
(318) 222-8511
(318) 222-3273
Mailing address
2000 FAIRFIELD AVENUE, SHREVEPORT, LA 71104
(318) 222-8511
(318) 222-3273
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
595
LA
Other
Enumeration date
11/26/2018
Last updated
11/26/2018
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