Individual
MR. ELLIOT JXAVIER LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RAC
Contact information
Practice address
2000 FAIRFIELD AVE, SHREVEPORT, LA 71104-2002
(318) 226-2890
Mailing address
525 CROCKETT ST, SHREVEPORT, LA 71101-3601
(318) 226-2890
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1438
LA
Other
Enumeration date
10/12/2017
Last updated
10/12/2017
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