Organization
SHACKLEFREE MINISTRIES
Active
Organization
SHACKLEFREE MINISTRIES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. VIRGINIA LEA TAYLOR BCLBT (CHRISTIAN COUNSELOR)
(903) 917-6632
Entity
Organization
Contact information
Practice address
409 N FREDONIA ST, SUITE 116, LONGVIEW, TX 75601-6466
(903) 917-6632
Mailing address
409 N FREDONIA ST, SUITE 116, LONGVIEW, TX 75601-6466
(903) 917-6632
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
10/26/2012
Last updated
10/26/2012
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