Individual
SHATERICA RAINEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9403 MANSFIELD RD, SHREVEPORT, LA 71118
(318) 861-8938
Mailing address
3601 DEE STREET APT 1103, SHREVEPORT, LA 71115
(318) 936-0005
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010354208
—
LA
Enumeration date
11/09/2016
Last updated
11/09/2016
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