Individual
EBONY COLLINSWORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
210 LAFAYETTE ST, RUSTON, LA 71270-4736
(318) 497-0956
Mailing address
210 LAFAYETTE ST, RUSTON, LA 71270-4736
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
02/19/2016
Last updated
02/19/2016
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