Individual
JUSTIN DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
458 HERNDON ST, SHREVEPORT, LA 71101-4859
(318) 429-6938
Mailing address
458 HERNDON ST, SHREVEPORT, LA 71101-4859
(318) 429-6938
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LPC5961
LA
Other
Enumeration date
11/24/2015
Last updated
08/22/2022
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