Individual
INNIS ADDISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
200 N THOMAS DR, SUITE 100, SHREVEPORT, LA 71107-6503
(318) 424-8345
Mailing address
7607 FERN AVE STE 902, SHREVEPORT, LA 71105-5745
(318) 524-9954
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
03/01/2017
Last updated
06/12/2019
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