Individual
SHANNON STEWART GRESHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., L.A.C.
Contact information
Practice address
1313 RINGGOLD AVE, COUSHATTA, LA 71019-9078
(318) 932-4029
(318) 932-5914
Mailing address
1313 RINGGOLD AVE, COUSHATTA, LA 71019-9078
(318) 932-4029
(318) 932-5914
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
LAC #1408
LA
Other
Enumeration date
11/15/2013
Last updated
11/15/2013
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